MIDWAY CLINICAL NEUROPSYCHOLOGIC INSTITUTE AND CHILDREN'S WELLNESS FOU (NPI# 1578023156) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578023156 |
| Entity Type | Organization |
| Organization Name | MIDWAY CLINICAL NEUROPSYCHOLOGIC INSTITUTE AND CHILDREN'S WELLNESS FOU |
| Practice Address |
1024 60th Street Suite 5 Kenosha WI 53140-4099 |
| Mailing Address |
P.o. Box 684 Kenosha WI 53141-0684 |
| Practice Telephone | 2624552919 |
| Practice Fax Number | 2624552919 |
| Mailing Telephone | 2624552919 |
| Mailing Fax Number | 2624552919 |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2019-03-21 |
| Authorized Official Name | DR. SHELLIE D. LOCKE (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2624552919 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103G00000X | Clinical Neuropsychologist | Behavioral Health & Social Service Providers | ||
| Y | 103T00000X | Psychologist | Behavioral Health & Social Service Providers |
| Street Address |
1024 60TH STREET SUITE 5 |
| City | KENOSHA |
| State | WI |
| Zip Code | 53140-4099 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225663396 | Lydia Zopf | Counselor | 2001 Alford Park Dr., Carthage College, Kenosha, WI 53140 | 2020-03-09 |
| 1952949406 | Rotate Rehabilitation and Performance | Physical Therapist | 5606 6th Avenue Suite Ll9, Kenosha, WI 53140 | 2019-12-16 |
| 1134778590 | Brenda Chiapetta | Registered Nurse | 3233 23rd Ave, Kenosha, WI 53140 | 2019-09-09 |
| 1275003394 | Kimberly Shaffner | Family Medicine | 4536 22nd Avenue, Kenosha, WI 53140 | 2018-12-01 |
| 1659863389 | Bart L Mengo | Contractor | 1715 60th Street, Kenosha, WI 53140 | 2018-05-30 |
| 1093182941 | Guided Wellness Counseling | Community/Behavioral Health | 1112 56th St, Kenosha, WI 53140 | 2015-08-26 |
| 1376970764 | Stacey L Andersen | Acupuncturist | 5603 7th Ave, Kenosha, WI 53140 | 2013-10-01 |
| 1841467438 | Deborah Schwerdtfeger | Occupational Therapy Assistant | 3415 Sheridan Road, Woodstock Rehab Dept, Kenosha, WI 53140 | 2008-05-13 |
| 1942492020 | Rebecca Ann Burdette | Counselor | 920 60th Street, Renosha, WI 53140 | 2007-08-13 |
| 1851598619 | Aurora Medical Group, Inc. | Durable Medical Equipment & Medical Supplies | 2707 15th Place, Kenosha, WI 53140 | 2007-06-27 |
| Find all providers in zip 53140 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396201455 | Pathways Counseling Services | Psychologist | 1025 56th St, Kenosha, WI 53140-3737 | 2019-02-13 |
| 1376720359 | Katherine M Flynn | Psychologist | 12225 71st St, Kenosha, WI 53142-7320 | 2008-01-22 |
| 1407294937 | David T Marx | Psychologist | 4536 22nd Ave, Kenosha, WI 53140-5917 | 2013-06-06 |
| 1558642629 | Rebecca Bons | Psychologist | 12225 71st St, Kenosha, WI 53142-7320 | 2011-09-02 |
| 1396039632 | Danielle Defreese | Psychologist | 10400 75th St, Kenosha, WI 53142-7884 | 2011-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205445590 | Elizabeth Ann Mullen-houser | Psychologist | 1507 Winnebago St, La Crosse, WI 54601-4967 | 2020-07-23 |
| 1073138327 | Rachel Kahn | Psychologist | 501 Acacia Ln, Madison, WI 53716-3238 | 2020-06-12 |
| 1184248593 | Jill Mallin | Psychologist | 10 S Water St E, Fort Atkinson, WI 53538-2053 | 2020-06-01 |
| 1669095303 | Generational Cycles LLC | Psychologist | 2208 W Rohr Ave, Milwaukee, WI 53209-5057 | 2020-05-27 |
| 1518529718 | Ellen Marie Meier-licht | Psychologist | 200 N Mall Dr, Appleton, WI 54913-8500 | 2019-07-08 |
| 1396309076 | John Nathaniel Greene Jr. | Psychologist | 6100 N 42nd St, Milwaukee, WI 53209-3560 | 2019-04-27 |
| 1912461385 | We All Rise Counseling Services LLC | Psychologist | 529 S Jefferson St Ste 201, Green Bay, WI 54301-4125 | 2019-01-30 |
| 1417426925 | Edward Dow | Psychologist | W268n1988 Shooting Star Road, Pewaukee, WI 53072 | 2018-11-14 |
| 1295202976 | Pkm Clinical Solutions LLC | Psychologist | W206s7867 Pasadena Dr, Muskego, WI 53150-9532 | 2018-10-31 |
| 1649747486 | Celeste Hunter | Psychologist | 2916 Marketplace Dr Ste 104, Fitchburg, WI 53719-5327 | 2018-10-30 |
| 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.