NPIMap

Organization Active NPI

Raeann Wichlacz

  • Addiction (Substance Use Disorder) Counselor
  • Abbotsford, WI
National Provider Identifier
1508840992
Registry record updated Jun 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
11042 Issued in WI
Legal business name
RAEANN WICHLACZ
Doing business as
Courage To Change Recovery
Practice address
106 Galvin Road
Abbotsford, WI 54405
Phone
(715) 223-0480
Fax
(715) 223-1611
NPI assigned
Nov 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2008

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

Authorized official

Name
Mrs. Raeann Wichlacz, CADC IIINPI 1942253315
Title
Owner
Phone
(715) 223-0480

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 11042 WI Primary

Addresses

Primary practice location

106 Galvin Road
Abbotsford, WI 54405

Mailing address

PO Box 447
106 Galvin Road
Abbotsford, WI 54405
Phone (715) 223-0480

Other identifiers 1

IdentifierTypeStateIssuer
42215300MedicaidWI

Other names 1

  • Courage To Change Recovery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090612000495 WI Part B Supplier - Clinic/Group Practice 3678623675 Receives reassigned benefits from 1 practitioner
Practice locations: Medford, WI; Abbotsford, WI

National Provider Directory

National Provider Directory

Locations

123 W State St
Ste 4
Medford, WI 54451
Phone (715) 223-0480

188 N Lake Ave
Phillips, WI 54555
Phone (715) 223-0480

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1508840992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 447",
            "address_2": "106 GALVIN ROAD",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "54405",
            "telephone_number": "715-223-0480",
            "fax_number": "715-223-1611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 GALVIN ROAD",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "54405",
            "telephone_number": "715-223-0480",
            "fax_number": "715-223-1611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RAEANN WICHLACZ",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-30",
        "last_updated": "2008-06-13",
        "status": "A",
        "authorized_official_last_name": "WICHLACZ",
        "authorized_official_first_name": "RAEANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-223-0480",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CADC III"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "11042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42215300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Courage To Change Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Abbotsford, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2008; 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.