WISCONSIN EATING DISORDER SPECIALISTS SC (NPI# 1801807375) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801807375 |
| Entity Type | Organization |
| Organization Name | WISCONSIN EATING DISORDER SPECIALISTS SC |
| Practice Address |
34700 Valley Rd Oconomowoc WI 53066-4500 |
| Mailing Address |
3630 N Hickory Ln Oconomowoc WI 53066-4532 |
| Practice Telephone | 2626461387 |
| Practice Fax Number | 2626467067 |
| Mailing Telephone | 2626461387 |
| Mailing Fax Number | 2626467067 |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | THEODORE WELTZIN (OWNER) |
| Authorized Official Telephone | 2626464411 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 283Q00000X | Psychiatric Hospital | Hospitals |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21282400 | 05 |
| Street Address |
34700 VALLEY RD |
| City | OCONOMOWOC |
| State | WI |
| Zip Code | 53066-4500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518959436 | Bradley Christopher Riemann | Psychologist | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2005-08-17 |
| 1508477142 | Kiah Allen | Nurse Practitioner | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2020-08-16 |
| 1477183069 | Beth Marie Calvert | Nurse Practitioner | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2020-01-22 |
| 1609410364 | Lateisha Prescott | Registered Nurse | 34700 Valley Rd, Oconomowoc, WI 53066-4599 | 2019-11-05 |
| 1508342130 | Allison Ann Barton | Registered Nurse | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2018-07-17 |
| 1821503640 | Nicholas R Farrell | Psychologist | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2017-12-04 |
| 1699291757 | Laura Ann Heidelmeier | Nurse Practitioner | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2017-08-20 |
| 1508388927 | Hilary Kay Boyd | Nurse Practitioner | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2017-07-07 |
| 1275929051 | Nicholas Edward Mahoney | Psychiatry & Neurology | 34700 Valley Rd, Oconomowoc, WI 53066 | 2015-04-08 |
| 1013346725 | Jodi Tompitch | Nurse Practitioner | 34700 Valley Rd, Oconomowoc, WI 53066-4500 | 2013-11-03 |
| Find all providers in the same location | ||||
| 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 | 283Q00000X |
| Grouping | Hospitals |
| Classification | Psychiatric Hospital |
| An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings. |
| Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003413816 | Sbh-madison LLC | Psychiatric Hospital | 3169 Deming Way, Middleton, WI 53562-1435 | 2020-10-05 |
| 1164736021 | Andrew Jay Kessler | Psychiatric Hospital | 1west Lincoln Avenue, Waupun, WI 53595 | 2010-08-03 |
| 1801908975 | County of Brown | Psychiatric Hospital | 3150 Gershwin Drive, Green Bay, WI 54311-5859 | 2006-08-31 |
| 1083728612 | County of Milwaukee | Psychiatric Hospital | 9455 W Watertown Plank Rd, Milwaukee, WI 53226-3559 | 2006-08-19 |
| 1205292869 | Veteran Health Administration | Psychiatric Hospital | 2500 Overlook Ter, Madison, WI 53705-2254 | 2016-01-12 |
| 1013212810 | Milwaukee County Behavioral Health | Psychiatric Hospital | 9201 W Watertown Plank Rd, Milwaukee, WI 53226-3558 | 2011-01-26 |
| 1104139021 | Wfhc - All Saints | Psychiatric Hospital | 1320 Wisconsin Ave, Racine, WI 53403-1978 | 2010-07-20 |
| 1053588293 | Joanne Zimmerman | Psychiatric Hospital | 9455 W Watertown Plank Rd, Milwaukee, WI 53226-3559 | 2008-05-15 |
| 1407988892 | County of Waukesha Department of Finance | Psychiatric Hospital | 1501 Airport Rd, Waukesha, WI 53188-3632 | 2007-03-12 |
| 1164516506 | State of Wisconsin | Psychiatric Hospital | 1300 South Drive, Winnebago, WI 54985-0009 | 2006-10-02 |
| Find all providers with the same taxonomy | ||||
| City | OCONOMOWOC |
| Zip Code | 53066 |
Please comment or provide details below to improve the information on WISCONSIN EATING DISORDER SPECIALISTS SC.
| 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.