| Center For Life & Loss Integration | |
|
4123 Monona Dr Monona WI 53716-1661 | |
| (608) 258-7771 | |
| (608) 832-6486 |
| Full Name | Center For Life & Loss Integration |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4123 Monona Dr, Monona, Wisconsin |
| Authorized Official Name and Position | Judith F. Koeppl (DIRECTOR) |
| Authorized Official Contact | 6082587771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Center For Life & Loss Integration 4123 Monona Dr Monona WI 53716-1661 Ph: (608) 258-7771 | Center For Life & Loss Integration 4123 Monona Dr Monona WI 53716-1661 Ph: (608) 258-7771 |
| NPI Number | 1073780961 |
|---|---|
| Provider Enumeration Date | 05/11/2008 |
| Last Update Date | 05/11/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073780961 | NPI | - | NPPES |
| 42245700 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 1842123 (Wisconsin) | Primary |
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