Sacred Wandering / Sacred Path Practitioners

Primary specialty

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

Legal business name

SACRED WANDERING / SACRED PATH PRACTITIONERS

Practice address

10134 N Port Washington Rd Ste G
Mequon, WI 53092-5700

Phone

(414) 433-9193

Fax

(414) 435-9611

NPI assigned

May 16, 2019

Last updated

May 16, 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

Kenneth J Nelan, MS, LPC, NCCNPI 1811342058

Title

Owner/Provider

Phone

(414) 433-9193

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Kenneth James Nelan, MS

  • Professional Counselor
  • Mequon, WI
  • NPI 1811342058
  NPD Authorized official

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

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557964800000",
    "number": "1780240614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10134 N PORT WASHINGTON RD STE G",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925700",
            "telephone_number": "414-433-9193",
            "fax_number": "414-435-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10134 N PORT WASHINGTON RD STE G",
            "city": "MEQUON",
            "state": "WI",
            "postal_code": "530925700",
            "telephone_number": "414-433-9193",
            "fax_number": "414-435-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SACRED WANDERING / SACRED PATH PRACTITIONERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-16",
        "last_updated": "2019-05-16",
        "status": "A",
        "authorized_official_last_name": "NELAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "414-433-9193",
        "authorized_official_credential": "MS, LPC, NCC"
    },
    "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": []
}

• Susan Ryack, PT
• Cathy E. Ryan, M.A.
• Stephan B. Ryan, AU.D. CCC-A
• Mikaella Sabinash, DDS
• Sacred Heart Rehabilitation Institute, Inc. (Ascension Sacred Heart Rehabilitation Hospital)
• Giovanna Safina
• Leena Saifuddin
• Sonia P Salazar, PA-C
• Sofia Salerno
• Lauren Elizabeth Tiehen Salit

• Mental Health Clinic/Center (Including Community Mental Health Center) in Mequon, WI
• Providers in Mequon, 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 May 16, 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.