LAKE GENEVA PSYCHOLOGY, INC. (NPI# 1972124980) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972124980 |
| Entity Type | Organization |
| Organization Name | LAKE GENEVA PSYCHOLOGY, INC. |
| Practice Address |
630 Kenosha St Walworth WI 53184-9505 |
| Mailing Address |
N1330 Overland Ln Lake Geneva WI 53147-7302 |
| Practice Telephone | 3059899030 |
| Mailing Telephone | 3059899030 |
| Enumeration Date | 2020-04-30 |
| Last Update Date | 2020-04-30 |
| Authorized Official Name | DR. AMY SOSA (DIRECTOR/OWNER) |
| Authorized Official Telephone | 3059899030 |
| Authorized Official Credential | PSY.D., CEDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
Behavioral Health & Social Service Providers |
| Street Address |
630 KENOSHA ST |
| City | WALWORTH |
| State | WI |
| Zip Code | 53184-9505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558835637 | Susan Jane Diderich | Registered Nurse | 211 Bonito St, Walworth, WI 53184 | 2019-01-11 |
| 1104007764 | Big Foot Union High School | Local Education Agency (LEA) | 401 Devils Ln, 99, Walworth, WI 53184 | 2007-11-23 |
| 1821149758 | Glenn Alan Wergin | Dentist | 100 N Main St, Walworth, WI 53184 | 2007-01-16 |
| 1891802344 | Janis A Lowell | Family Medicine | 525 Kenosha St, #a, Walworth, WI 53184 | 2006-08-23 |
| 1346357860 | Dale Gary Jacobson | Family Medicine | 525 Kenosha St, #a, Walworth, WI 53184 | 2006-08-23 |
| 1730198870 | Deana L Courier | Family Medicine | 525 Kenosha St, #a, Walworth, WI 53184 | 2006-08-07 |
| 1821236506 | Jennifer L Van Vleet | Registered Nurse | N2348 County Road F, Walworth, WI 53184-5662 | 2009-02-03 |
| 1619117488 | Victoria Ann Knull | Registered Nurse | 126 Howard St, Walworth, WI 53184-9509 | 2009-03-05 |
| 1881703676 | Mccullough Pharmacy Inc | Pharmacy | 547 Kenosha St, Walworth, WI 53184-9512 | 2006-08-29 |
| 1962436188 | Aurora Pharmacy Inc | Pharmacy | 525 Kenosha St, Suite C, Walworth, WI 53184-9512 | 2006-07-11 |
| Find all providers in zip 53184 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 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 |
| 1407327844 | Deborah Ann Pape | Psychologist | 350 S. Hamilton St., Unit 504, Madison, WI 53703 | 2018-12-11 |
| 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.