Provider Demographics
NPI:1104848183
Name:CONTINENCE & PELVIC WELLNESS CLINIC SC
Entity Type:Organization
Organization Name:CONTINENCE & PELVIC WELLNESS CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERESE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HILDENBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:262-240-1202
Mailing Address - Street 1:1516 W MEQUON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-240-1202
Mailing Address - Fax:262-240-1205
Practice Address - Street 1:1516 W MEQUON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-240-1202
Practice Address - Fax:262-240-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41012700Medicaid
WI41012700Medicaid