Provider Demographics
NPI:1467496729
Name:PATHWAYS CONSULTING OF KENOSHA LLC
Entity Type:Organization
Organization Name:PATHWAYS CONSULTING OF KENOSHA LLC
Other - Org Name:PATHWAYS CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORA
Authorized Official - Middle Name:SCHULTZ
Authorized Official - Last Name:REINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-652-7222
Mailing Address - Street 1:4633 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4220
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1734
Practice Address - Street 1:4633 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-3552
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
WI2248261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI496271OtherVALUE OPTIONS
WI42231700Medicaid
WI861097264010OtherBLUE CROSS & BLUE SHIELD
WI102546132585OtherHUMANA
WI0044780Medicare ID - Type Unspecified
WI42231700Medicaid