Dana Michelle Ballewske, PSY D
Individual provider Active NPI Clinical Psychologist · Kenosha, WI
NPI 1821345372 · NPPES record last updated Mar 30, 2020
Key facts
- NPI
- 1821345372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 3646 (WI)
- Practice address
- 2108 63Rd St
Kenosha, WI 53143-4454 - Phone
- (262) 652-2406
- NPI assigned
- Aug 14, 2012
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3646 | WI | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3646 | WI | Yes |
Addresses
Primary practice location
2108 63Rd St
Kenosha, WI 53143-4454
Mailing address
2108 63Rd St
Kenosha, WI 53143-4454
Phone (262) 652-2406
Other providers in Kenosha, WI
- Chloe Baker Wachowiacz
- Annette Bale
- Narayan Baliga
- Balistreri & Associates Physical Therapy
- Jodi Ball
- Geetha Bandealy
- Malik T Bandealy
- Kathy L Bandstra
- Daniel Baran
- Kayla Marie Baran
All providers in Kenosha, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.