DYNAMIC POTENTIAL (NPI# 1023656162) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023656162 |
| Entity Type | Organization |
| Organization Name | DYNAMIC POTENTIAL |
| Practice Address |
316 5th St Ste 2 Racine WI 53403-4606 |
| Mailing Address |
Po Box 1943 Kenosha WI 53141-1943 |
| Practice Telephone | 2623088085 |
| Mailing Telephone | 2623088085 |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2020-02-24 |
| Authorized Official Name | DR. STEPHANIE R RASZKIEWICZ (LICENSED PSYCHOLOGIST) |
| Authorized Official Telephone | 2623088085 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103TA0400X |
Psychologist Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| N | 103TF0000X |
Psychologist Specialization: Family |
Behavioral Health & Social Service Providers | ||
| Y | 103TC1900X |
Psychologist Specialization: Counseling |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 40968000 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | DYNAMIC POTENTIAL EXECUTIVE COACHING | 60809 Cobblestone Pl, Bend, OR 97702 |
| Oregon Corporations, Companies and Business Names | DYNAMIC POTENTIAL EXECUTIVE COACHING, LLC | 38 Canto Del Pajaro, Santa Fe, NM 87508 |
| Colorado Business Entities | Dynamic Potential LLC | 4878 Wandering Cir, Colorado Springs, CO 80917 |
| Street Address |
316 5TH ST STE 2 |
| City | RACINE |
| State | WI |
| Zip Code | 53403-4606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124676259 | Quality Care LLC | Clinic/Center | 2051 Mead St, Racine, WI 53403 | 2019-09-02 |
| 1073999355 | Wisconsin Lutheran Child & Family Service, Inc. | Social Worker | 6150 Taylor Avenue, Racine, WI 53403 | 2015-08-10 |
| 1457780496 | Pheynell Branch | Counselor | 1650 Wasington Ave, Racine, WI 53403 | 2013-11-08 |
| 1811278054 | Michelle Gloria Parisot | Psychologist | 1320 Wisconsin Ave., Racine, WI 53403 | 2011-09-01 |
| 1720372022 | Katie Hagen | Social Worker | 1717 Taylor Avenue, Racine, WI 53403 | 2011-06-03 |
| 1043431570 | Rita S Harris | Physical Therapy Assistant | Lakeshore Manor 1320 Wisconsin Avenue, Racine, WI 53403 | 2007-05-01 |
| 1336281336 | Linda J Hockensmith | Occupational Therapist | 4214 Sheridan Road, Racine, WI 53403 | 2007-02-13 |
| 1851447387 | Richard John Kemper | Dentist | 1509 Washington Ave, Racine, WI 53403 | 2007-01-26 |
| 1689760332 | Lester Leslie Higgenbottom | Counselor | 1820 Arlington Ave, Racine, WI 53403 | 2006-10-04 |
| 1114942315 | Access Medical Center, LLC | Clinic/Center | 4216 Old Green Bay Rd, Racine, WI 53403 | 2006-07-12 |
| Find all providers in zip 53403 | ||||
| Taxonomy Code | 103TC1900X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Counseling |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629607619 | Eleanor Arlene Tidball | Psychologist | 13320 W Grange Ave, New Berlin, WI 53151-8131 | 2020-04-02 |
| 1134769441 | Graham Gardner Knowlton | Psychologist | Milwaukee Vamc 5000 W National Ave, Milwaukee, WI 53295-0001 | 2020-01-14 |
| 1477197929 | Samuel David Lustgarten | Psychologist | 1025 W Johnson St Rm 303b, Madison, WI 53706-1706 | 2019-10-28 |
| 1467095703 | Ifrah Hameed | Psychologist | 1849 N Doctor M.l.k. Jr Dr# 101, Milwaukee, WI 53212 | 2019-10-18 |
| 1770133555 | Kerrin Sendrowitz O'connor | Psychologist | 1509 S Outagamie St, Appleton, WI 54914-5580 | 2019-09-13 |
| 1982193546 | Samantha Jo Schwartz-oscar | Psychologist | 2809 School Rd, Greenleaf, WI 54126-9209 | 2018-05-08 |
| 1790202851 | Wisconsin Lutheran Child & Family Service | Psychologist | 2669 N Richards St, Milwaukee, WI 53212-2850 | 2017-08-29 |
| 1902337785 | Carla Mae Davey | Psychologist | 333 E Campus Mall Rm 7, University Health Services, Madison, WI 53715-1740 | 2017-03-23 |
| 1558739300 | Hayley Shilling | Psychologist | 6602 Grand Teton Plz Ste 100, Madison, WI 53719-2905 | 2015-09-10 |
| 1568850840 | Belinda Gutierrez | Psychologist | 2500 Overlook Terrace, 116b, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705-2286 | 2015-01-08 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.