Midway Clinical Neuropsychologic Institute and Children's Wellness Fou

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MIDWAY CLINICAL NEUROPSYCHOLOGIC INSTITUTE AND CHILDREN'S WELLNESS FOU

Practice address

1024 60TH Street
Suite 5
Kenosha, WI 53140-4099

Phone

(262) 455-2919

Fax

(262) 455-2919

NPI assigned

Mar 21, 2019

Last updated

Mar 21, 2019By 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

Dr. Shellie D. Locke, PHD

Title

Chief Executive Officer

Phone

(262) 455-2919

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1578023156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 684",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531410684",
            "telephone_number": "262-455-2919",
            "fax_number": "262-455-2919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 60TH STREET",
            "address_2": "SUITE 5",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531404099",
            "telephone_number": "262-455-2919",
            "fax_number": "262-455-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY CLINICAL NEUROPSYCHOLOGIC INSTITUTE AND CHILDREN'S WELLNESS FOU",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "SHELLIE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "262-455-2919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Fox, R.D.H.,S.C.
• Carla Michels
• Carol Margaret Michels, OTR
• Rachael Midday, DPT, CKTP
• Hannah Lyn Midlock
• Midway Manor Corp. (Clairidge House)
• Midwest Alignment Center,LLC
• Midwest Center for Women's Health
• Midwest Center for Womens Health S.C.
• Midwest Family Support Services

• Psychologist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.