Provider Demographics
NPI:1376305219
Name:RED CEDAR PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:RED CEDAR PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MABRY-HILLESHIEM
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:715-505-6105
Mailing Address - Street 1:E5948 510TH AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-5610
Mailing Address - Country:US
Mailing Address - Phone:715-505-6105
Mailing Address - Fax:
Practice Address - Street 1:3120 SCHNEIDER AVE SE STE 606
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2591
Practice Address - Country:US
Practice Address - Phone:715-505-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)