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Organization Active NPI

Northwest Journey - Menomonie Day Treatment

  • Adolescent and Children Mental Health Clinic/Center
  • Menomonie, WI
National Provider Identifier
1770600413
Registry record updated Sep 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
2660 Issued in WI
Legal business name
NORTHWEST JOURNEY - MENOMONIE DAY TREATMENT
Practice address
402 Technology Drive E
Menomonie, WI 54751
Phone
(718) 523-5424
Fax
(715) 235-4421
NPI assigned
Mar 26, 2007
Organization subpart
Yes
Parent organization
NORTHWEST COUNSELING AND GUIDANCE CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 23, 2010

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

Authorized official

Name
Mr. Nick Kalambokidis
Title
Cfo
Phone
(715) 327-4402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X 2660 WI Primary

Addresses

Primary practice location

402 Technology Drive E
Menomonie, WI 54751

Mailing address

402 Technology Drive E
Menomonie, WI 54751
Phone (718) 523-5424

Other identifiers 3

IdentifierTypeStateIssuer
42626OtherMNHEALTH PARTNERS
43009000MedicaidWI
85575OtherMNPREFERRED ONE

National Provider Directory

National Provider Directory
Tax ID family
Northwest Counseling Center22 organizations share this tax ID, including this one
Part of
Northwest Counseling Center

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

402 Technology Dr E
Menomonie, WI 54751
Phone (715) 235-4245

Practitioners & affiliated clinicians

Practitioners 4

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": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285200000000",
    "number": "1770600413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 TECHNOLOGY DRIVE E",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "54751",
            "telephone_number": "718-523-5424",
            "fax_number": "715-235-4421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 TECHNOLOGY DRIVE E",
            "city": "MENOMONIE",
            "state": "WI",
            "postal_code": "54751",
            "telephone_number": "718-523-5424",
            "fax_number": "715-235-4421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST JOURNEY - MENOMONIE DAY TREATMENT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHWEST COUNSELING AND GUIDANCE CLINIC",
        "enumeration_date": "2007-03-26",
        "last_updated": "2010-09-23",
        "status": "A",
        "authorized_official_last_name": "KALAMBOKIDIS",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-327-4402",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "2660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "42626",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43009000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "85575",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Menomonie, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2010; 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.