Sweetgrass Behavioral Health

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

SWEETGRASS BEHAVIORAL HEALTH

Practice address

102 E Green Bay St Ste 101
Shawano, WI 54166-2444

Phone

(715) 280-8130

Fax

(715) 280-8138

NPI assigned

Nov 10, 2022

Last updated

Dec 20, 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

Alegra Fowler, LCSWNPI 1962056382

Title

Owner

Phone

(715) 280-8130

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

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.

• Alegra N Fowler, LCSW

  • Clinical Social Worker
  • Shawano, WI
  • NPI 1962056382
  Medicare reassignment NPD Authorized official
• Amanda E Baddmoccosin-Barnes, LCSW

  • Clinical Social Worker
  • Shawano, WI
  • NPI 1114592805
  NPD (past)

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

{
    "created_epoch": "1668038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671494400000",
    "number": "1508574328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E GREEN BAY ST STE 101",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662444",
            "telephone_number": "715-280-8130",
            "fax_number": "715-280-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E GREEN BAY ST STE 101",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662444",
            "telephone_number": "715-280-8130",
            "fax_number": "715-280-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SWEETGRASS BEHAVIORAL HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-10",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "ALEGRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-280-8130",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William James Stern, O.D.
• Rebecca Marie Stevens, DDS
• Strive Behavioral Solutions, LLC (Strive Behavioral Solutions)
• Amy Stuber, D.C.
• Gene Anthony Stuber
• William P Swetlik, D.D.S., M.S.
• Synergy Counseling Services, Inc
• Gregory Thatcher, MD
• Patricia Ann Thatcher, P.T.
• Thedacare Medical Center - Shawano, Inc.

• Adolescent and Children Mental Health Clinic/Center in Shawano, WI
• Providers in Shawano, WI by specialty
• Adolescent and Children Mental Health Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.