SOUTH STREET CLINIC LLC (NPI# 1235128356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235128356 |
| Entity Type | Organization |
| Organization Name | SOUTH STREET CLINIC LLC |
| Practice Address |
416 W South St Oconomowoc WI 53066-2755 |
| Practice Telephone | 2625677673 |
| Practice Fax Number | 2625673097 |
| Mailing Telephone | 2625677673 |
| Mailing Fax Number | 2625673097 |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. ANNE ALEXA WESTON (CLINIC OWNER) |
| Authorized Official Telephone | 2625677673 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
1841 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 42217900 | 05 |
| Street Address |
416 W SOUTH ST |
| City | OCONOMOWOC |
| State | WI |
| Zip Code | 53066-2755 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548259658 | Cynthia Lee Peters | Counselor | 416 W South St, Oconomowoc, WI 53066-2755 | 2005-10-20 |
| 1972592095 | Maejeanne Fancher | Social Worker | 416 W South St, Oconomowoc, WI 53066-2755 | 2005-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376109082 | Sharon Legwinski | Occupational Therapist | 2195 N. Summit Way, Oconomowoc, WI 53066 | 2019-05-17 |
| 1033676390 | Paladina Health, LLC | Family Medicine | Paladina Health Oconomowoc Sentry Equipment Circle, 966 Blue Ribbon Circle N, Oconomowoc, WI 53066 | 2019-02-22 |
| 1689145500 | Oconomowoc Developmental Training Center of Wisconsin LLC | Residential Treatment Facility, Emotionally Disturbed Children | 36100 Genesee Lake School, Oconomowoc, WI 53066 | 2018-12-17 |
| 1649748203 | Ginny Dacquisto | Dietitian, Registered | 1134 Lily Rd, Oconomowoc, WI 53066 | 2018-11-12 |
| 1174000764 | Aimee M Metzger | Social Worker | 405 E Forest St Ste 113, Oconomowoc, WI 53066 | 2018-07-26 |
| 1023482569 | Forefront Dermatology, S.c. | Dermatology | 1320 Pabst Farms Cir, Suite 180, Oconomowoc, WI 53066 | 2015-11-20 |
| 1962890475 | Monica Rodriguez | Counselor | 405 East Forest Street, Suite 119, Oconomowoc, WI 53066 | 2015-01-06 |
| 1518384643 | Kimberley Bevan | Pharmacist | 1284 East Summit Avenue, Suite 100, Oconomowoc, WI 53066 | 2014-03-26 |
| 1699098905 | Heidi Eckroth Nunnemacher | Counselor | 35315 Genesee Lake Road, Oconomowoc, WI 53066 | 2010-03-02 |
| 1669705240 | Oconomowoc Development Training Center Ll | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 3222 N. Silver Cedar Rd., Oconomowoc, WI 53066 | 2009-09-14 |
| Find all providers in zip 53066 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639168750 | Anne Alexa Weston | Psychologist | 416 South St, Oconomowoc, WI 53066 | 2005-10-20 |
| 1225037575 | Joan Carol Russo | Psychologist | W340n6509 Breezy Point Rd, Oconomowoc, WI 53066-5132 | 2005-07-19 |
| 1881716108 | Center for Anxiety Disorders | Psychologist | 436 Summit Ave, Oconomowoc, WI 53066-3749 | 2007-04-06 |
| 1245245794 | A New Day Psychological Services LLC | Psychologist | 970 S Silver Lake St, Suite 103, Oconomowoc, WI 53066-3802 | 2006-07-30 |
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|---|---|---|---|---|
| 1881295863 | Emotive Action Counseling Services LLC | Psychologist | 9235 W Capitol Dr Ste 402, Milwaukee, WI 53222-1567 | 2020-11-05 |
| 1710501168 | Thomas Speech | Psychologist | 601 Kessler Dr., Neenah, WI 54956-4113 | 2020-06-02 |
| 1972124980 | Lake Geneva Psychology, Inc. | Psychologist | 630 Kenosha St, Walworth, WI 53184-9505 | 2020-04-30 |
| 1487283669 | Maria Gambaro | Psychologist | W4557 Gillette Dr, Montello, WI 53949-8951 | 2020-04-08 |
| 1386283810 | Troy William Sheide | Psychologist | 498 Ruggles St, Fond Du Lac, WI 54935-3931 | 2020-01-01 |
| 1871138115 | Point Counseling Center LLC | Psychologist | 1547 Strongs Ave Ste D, Stevens Point, WI 54481-3566 | 2019-11-11 |
| 1508417916 | Cassandra D Pasquariello | Psychologist | Department of Athletics, 1440 Monroe Street, Madison, WI 53711 | 2019-09-26 |
| 1023673563 | Robert E Young | Psychologist | 735 N Water St Ste 712, Milwaukee, WI 53202-4104 | 2019-05-09 |
| 1346705951 | Joseph John Abhold | Psychologist | 402 Graham Ave Ste 208, Eau Claire, WI 54701-2633 | 2019-02-07 |
| 1972075661 | Moonlight Psychotherapy and Psychological Services, LLC | Psychologist | 205 5th Ave S Ste 428, La Crosse, WI 54601-4059 | 2018-12-19 |
| Find all providers with the same taxonomy | ||||
| City | OCONOMOWOC |
| Zip Code | 53066 |
Please comment or provide details below to improve the information on SOUTH STREET CLINIC LLC.
| 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.