Northeast Wisconsin Wellness Associates, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

NORTHEAST WISCONSIN WELLNESS ASSOCIATES, LLC

Practice address

1941 Lehrer LN
Kaukauna, WI 54130-7704

Phone

(920) 766-5040

Fax

(920) 497-3135

NPI assigned

Feb 19, 2024

Organization subpart

No

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

Authorized official

Name

Diane Moga Roach, LCSWNPI 1700923471

Title

Owner

Phone

(920) 766-5040

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Diane M Moga-Roach, MSE, LCSW, LPC, CEAP

  • Professional Counselor
  • Green Bay, WI
  • NPI 1700923471
  NPD Authorized official
• Molly Marie Barrett, APSW

  • Social Worker
  • Kaukauna, WI
  • NPI 1811765100
  NPD

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1699530683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 LEHRER LN",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541307704",
            "telephone_number": "920-766-5040",
            "fax_number": "920-497-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 LEHRER LN",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541307704",
            "telephone_number": "920-766-5040",
            "fax_number": "920-497-3135"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2830 Ramada Way Lowr Level",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543045700",
            "country_code": "US",
            "telephone_number": "920-497-6200",
            "fax_number": "920-497-3135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHEAST WISCONSIN WELLNESS ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "MOGA ROACH",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-766-5040",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Kaukauna, WI
• Providers in Kaukauna, WI by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; 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.