ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC (NPI# 1346233350) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346233350 |
| Entity Type | Organization |
| Organization Name | ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC |
| Practice Address |
4404 State Road 70 Webster WI 54893-9251 |
| Practice Telephone | 8774551901 |
| Practice Fax Number | 7153498528 |
| Mailing Telephone | 8774551901 |
| Mailing Fax Number | 7153498528 |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2011-10-19 |
| Authorized Official Name | MRS. SHELLEY HAMMES (BEHAVIORAL HEALTH DIRECTOR) |
| Authorized Official Telephone | 8774551901 |
| Authorized Official Credential | MS, CSAC, ICS |
| Is Organization Subpart | Y |
| Parent Organization Name | ST. CROIX CHIPPEWA INDIANS OF WI |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
2217 | WI | Behavioral Health & Social Service Providers |
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
2217 | WI | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 42220400 | 05 |
| Street Address |
4404 STATE ROAD 70 |
| City | WEBSTER |
| State | WI |
| Zip Code | 54893-9251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124678818 | Muskadee Linda Montano | Social Worker | 4404 State Road 70, Webster, WI 54893-9251 | 2019-09-16 |
| 1194380543 | Deborah Ann Knutsen | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2019-05-01 |
| 1316415516 | Sandra Johnson | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-11-06 |
| 1801371190 | Dianna Kay Stumph | Registered Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-10-02 |
| 1184109597 | Lona Marie Noll | Licensed Practical Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-10-02 |
| 1598245045 | Kimberly M Stypula | Licensed Practical Nurse | 4404 State Road 70, Webster, WI 54893-9251 | 2018-08-15 |
| 1881171601 | Penny Lynn Bearheart | Counselor | 4404 State Road 70, Webster, WI 54893-9251 | 2018-07-24 |
| 1720573082 | Susan Evelyn Merchant | Dental Hygienist | 4404 State Road 70, Webster, WI 54893-9251 | 2018-06-28 |
| 1538652383 | Kayce R Rachner | Dental Hygienist | 4404 State Road 70, Webster, WI 54893-9251 | 2018-06-07 |
| 1164919833 | Karli Solum | Dietitian, Registered | 4404 State Road 70, Webster, WI 54893-9251 | 2018-04-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427288711 | Jamie Ruiz | Licensed Practical Nurse | 27105 Lily Lake Rd, Webster, WI 54893 | 2009-07-21 |
| 1487875787 | St. Croix Tribal Council | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 4404 State Rd 70, Webster, WI 54893 | 2007-05-02 |
| 1851421903 | St Croix Falls Eye Associates | Optometrist | 7440 Main St West, Webster, WI 54893 | 2007-03-07 |
| 1396823324 | Benjamin Dale Blowers | Chiropractor | 7461 Main St West, Webster, WI 54893-0095 | 2006-11-01 |
| 1699195065 | Shannon Steiner | Licensed Practical Nurse | 8757 Perida Rd, Webster, WI 54893-7422 | 2014-04-23 |
| 1861662678 | Cary Mitchell Behm | Chiropractor | 26768 Lakeland Ave N, Webster, WI 54893-8106 | 2008-03-07 |
| 1174673511 | John W Ingalls | Family Medicine | 7456 Main St W, Webster, WI 54893-8205 | 2007-01-10 |
| 1265950240 | Erin M Vogland | Nurse Practitioner | 7456 Main St W, Webster, WI 54893-8205 | 2017-08-30 |
| 1255627972 | Leah B Jacobs | Nurse Practitioner | 7456 Main St W, Webster, WI 54893-8205 | 2011-06-21 |
| 1477843258 | Kathryn Ann Freese | Physical Therapy Assistant | 7456 Main St W, Webster, WI 54893-8205 | 2011-04-13 |
| Find all providers in zip 54893 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689105835 | Jessica Gifford | Counselor | 807 Ridge Rd Ste 203, Webster, NY 14580-2497 | 2017-03-21 |
| 1881171601 | Penny Lynn Bearheart | Counselor | 4404 State Road 70, Webster, WI 54893-9251 | 2018-07-24 |
| 1043431497 | Catherine Delaney | Counselor | 560 Blossom St, Suite B, Webster, TX 77598-4236 | 2007-05-02 |
| 1487723763 | Shelley Lynn Hammes | Counselor | 4404 State Road 70, Webster, WI 54893-9251 | 2006-11-08 |
| 1871676528 | Kathryn Alice Schneider | Counselor | 4404 State Road 70, Webster, WI 54893 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891396255 | Cassandra C Coates | Counselor | 134 Main St Apt 117, Racine, WI 53403-4623 | 2020-11-03 |
| 1649879982 | Veronicia S Green | Counselor | 2821 N Vel R Phillips Ave Ste 131, Milwaukee, WI 53212-2370 | 2020-10-19 |
| 1578160974 | Jennifer A Nyman | Counselor | 2408 N 89th St, Wauwatosa, WI 53226-1804 | 2020-10-08 |
| 1558977991 | Guided Solutions Therapy, LLC | Counselor | 126 W Holum St, Deforest, WI 53532-1108 | 2020-09-21 |
| 1396359337 | Sarah Luetzow Marten | Counselor | 6441 Enterprise Ln Ste 101, Madison, WI 53719-1180 | 2020-09-08 |
| 1891313656 | Kayla Lynn Fazzari | Counselor | N168w20964 Main St, Jackson, WI 53037-9634 | 2020-07-08 |
| 1518580182 | Michele Denise Perron | Counselor | 912 Baxter Ave, Superior, WI 54880-1735 | 2020-05-18 |
| 1003438391 | Kimberly Rose Schlomann | Counselor | W227s10580 River Ave, Big Bend, WI 53103-9563 | 2020-05-10 |
| 1477174381 | Sarah Ross | Counselor | 302 West Lake St., Friendship, WI 55934 | 2020-05-01 |
| 1124657721 | Joanne Berthelsen Lcsw LLC | Counselor | 830 Armour Rd Ste 2, Oconomowoc, WI 53066-3959 | 2020-04-06 |
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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.