Grace Healing and Wellness Center, LLC.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GRACE HEALING AND WELLNESS CENTER, LLC.

Practice address

N28W23000 Roundy Dr Ste 105
Pewaukee, WI 53072-7300

Phone

(414) 350-6693

NPI assigned

May 26, 2022

Last updated

May 26, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angelique Lewis, PHDNPI 1295979714

Title

Psychologist

Phone

(414) 350-6693

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Angelique Lewis

  • Clinical Psychologist
  • Milwaukee, WI
  • NPI 1295979714
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1467190694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N28W23000 ROUNDY DR STE 105",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530727300",
            "telephone_number": "414-350-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N28W23000 ROUNDY DR STE 105",
            "city": "PEWAUKEE",
            "state": "WI",
            "postal_code": "530727300",
            "telephone_number": "414-350-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACE HEALING AND WELLNESS CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-26",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "ANGELIQUE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "414-350-6693",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003219",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shirley Y Godiwalla, MD
• Carl Goehner
• Golf Creek Family Chiropractic
• Good Harvest Market
• Paige Alexis Goodwin, OTR/L
• Rebecca Gray, PT
• Lauri Theresa Green, M.D.
• Bonnie-Jo McLean Grieve, M.D.
• Adam C Grimm, PA
• Jolyn Gundlach, DPT

• Clinical Psychologist in Pewaukee, WI
• Providers in Pewaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.