Provider Demographics
NPI:1356655393
Name:WESTERN WISCONSIN MUSIC IN MEDICINE, LLC
Entity Type:Organization
Organization Name:WESTERN WISCONSIN MUSIC IN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGUS
Authorized Official - Suffix:
Authorized Official - Credentials:COTA-NMT/L
Authorized Official - Phone:715-495-3768
Mailing Address - Street 1:S 806 COUTY ROAD H
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-8210
Mailing Address - Country:US
Mailing Address - Phone:715-495-3768
Mailing Address - Fax:715-926-5137
Practice Address - Street 1:S806 COUNTY ROAD H
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-8210
Practice Address - Country:US
Practice Address - Phone:715-495-3768
Practice Address - Fax:715-926-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1617-27224Z00000X
WI28038225A00000X
WI2363-26225X00000X
WI718241235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty