Dynamic Potential - Medicare Mental Health Clinic in Racine, WI

Dynamic Potential is a medicare enrolled mental health clinic (Psychologist - Counseling) in Racine, Wisconsin. The current practice location for Dynamic Potential is 316 5th St Ste 2, Racine, Wisconsin. For appointments, you can reach them via phone at (262) 308-8085. The mailing address for Dynamic Potential is Po Box 1943, Kenosha, Wisconsin and phone number is (262) 308-8085.

Dynamic Potential is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1023656162. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (262) 308-8085.

Contact Information

Dynamic Potential
316 5th St Ste 2
Racine
WI 53403-4606
(262) 308-8085
Not Available

Mental Health Clinic Profile

Full NameDynamic Potential
SpecialityPsychologist
Location316 5th St Ste 2, Racine, Wisconsin
Authorized Official Name and PositionStephanie R Raszkiewicz (LICENSED PSYCHOLOGIST)
Authorized Official Contact2623088085
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Dynamic Potential
Po Box 1943
Kenosha
WI 53141-1943

Ph: (262) 308-8085
Dynamic Potential
316 5th St Ste 2
Racine
WI 53403-4606

Ph: (262) 308-8085

NPI Details:

NPI Number1023656162
Provider Enumeration Date12/19/2019
Last Update Date02/24/2020
Certification Date02/24/2020

Medicare PECOS Information:

Medicare PECOS PAC ID4183051683
Medicare Enrollment IDO20200221002584

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Medical Identifiers

Medical identifiers for Dynamic Potential such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1023656162NPI-NPPES
40968000MedicaidWI

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
103TA0400XPsychologist - Addiction (substance Use Disorder) (* (Not Available))Secondary
103TC1900XPsychologist - Counseling (* (Not Available))Primary
103TF0000XPsychologist - Family (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Dynamic Potential acts as a billing entity for following providers:
Provider NameStephanie Raszkiewicz
Provider TypePractitioner - Clinical Psychologist
Provider IdentifiersNPI Number: 1952577629
PECOS PAC ID: 2466608708
Enrollment ID: I20120802000093

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