Provider Demographics
NPI:1528413739
Name:PATHWAY TO WELLNESS COMMUNITY CLINIC SC
Entity Type:Organization
Organization Name:PATHWAY TO WELLNESS COMMUNITY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-643-3663
Mailing Address - Street 1:560 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1136
Mailing Address - Country:US
Mailing Address - Phone:608-643-3663
Mailing Address - Fax:608-370-8177
Practice Address - Street 1:560 4TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1136
Practice Address - Country:US
Practice Address - Phone:608-370-8131
Practice Address - Fax:608-643-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty