Lakefront Wellness Center, SC
Organization Active NPI Clinical Psychologist · Pewaukee, WI
NPI 1316024847 · NPPES record last updated Aug 27, 2013
Key facts
- NPI
- 1316024847
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 2437 (WI)
- Legal business name
- LAKEFRONT WELLNESS CENTER, SC
- Practice address
- 161 W Wisconsin Ave Ste 2B
Pewaukee, WI 53072-3468 - Phone
- (262) 695-8857
- Fax
- (262) 695-8879
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Beth A. Johnson, PSY.D.
- Title
- Director
- Phone
- (262) 695-8857
Practitioners 13
-
Diana Lynn Bolmes, LCSW, CSAC
-
Richard J Bronecki, LISW, CEAP, SAP
-
Jill T Butterfield, M.S. ATRL-BC
-
Peter John Hansen, PHD
-
Nicole Eve Herdegen, ATRL-BC
-
Tyler Loomis, MA, LPC
-
Ariane Machin, PH.D.
-
Danielle E Sample, PSY.D.
-
Jennifer L Swanson, EDD
-
Ashley Thompson, LPC, LPCC
-
Sonya S Trueblood, PSYD
-
Stacy E Zinuticz, MS
-
Mary Lynne Mack, PHD
National Provider Directory
Locations
4065 N Calhoun Rd
Ste 201
Brookfield, WI 53005
Phone (262) 373-0553
521 Westover St
Oconomowoc, WI 53066
Phone (262) 695-8857
161 W Wisconsin Ave
Ste 2B
Pewaukee, WI 53072
Phone (262) 695-8857
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 2437 | WI | |
| Psychologist |
103T00000X | 2437 | WI | |
| Clinical Psychologist |
103TC0700X | 2437 | WI | Yes |
| Clinical Social Worker |
1041C0700X | 2437 | WI | |
| Marriage & Family Therapist |
106H00000X | 2437 | WI |
Addresses
Primary practice location
161 W Wisconsin Ave Ste 2B
Pewaukee, WI 53072-3468
Mailing address
161 W Wisconsin Ave Ste 2B
Pewaukee, WI 53072-3468
Phone (262) 695-8857
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42230900 | Medicaid | WI |
Other providers in Pewaukee, WI
- Luann M Ladwig
- Lake Country Counseling Service
- Lake Country Foot & Ankle SC
- Lake Country Foot & Ankle, S.C.
- Lake View Adult Family Home
- Abbey Mach Lamanna
- Shay Lange
- Heidi Laurel Lasnoski
- Katie Laufenberg
- Lauri Green M.D. S.C.
All providers in Pewaukee, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 27, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.