Provider Demographics
| NPI: | 1750326518 |
|---|---|
| Name: | MILWAUKEE CENTER FOR INDEPENDENCE INC |
| Entity Type: | Organization |
| Organization Name: | MILWAUKEE CENTER FOR INDEPENDENCE INC |
| Other - Org Name: | WHOLE HEALTH CLINICAL GROUP |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | PRESIDENT AND CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TERI |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | ZYWICKI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 414-937-2020 |
| Mailing Address - Street 1: | 2020 W WELLS ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MILWAUKEE |
| Mailing Address - State: | WI |
| Mailing Address - Zip Code: | 53233-2720 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 414-476-9675 |
| Mailing Address - Fax: | 414-557-1834 |
| Practice Address - Street 1: | 2020 W WELLS ST |
| Practice Address - Street 2: | |
| Practice Address - City: | MILWAUKEE |
| Practice Address - State: | WI |
| Practice Address - Zip Code: | 53233-2720 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 414-476-9675 |
| Practice Address - Fax: | 414-476-9615 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | MILWAUKEE CENTER FOR INDEPENDENCE |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-06-17 |
| Last Update Date: | 2023-01-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 101YP2500X, 103G00000X, 103T00000X, 103TC0700X, 103TH0004X, 103TR0400X, 104100000X, 1041C0700X, 163WP0809X, 2084P0800X, 251S00000X, 363LF0000X, 364SP0808X | ||
| WI | 1933 | 261QM0801X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
| No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 251S00000X | Agencies | Community/Behavioral Health | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 364SP0808X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| WI | DD9253 | Other | RAILROAD MEDICARE PART B |
| WI | 42128300 | Medicaid | |
| WI | DD9253 | Other | RAILROAD MEDICARE PART B |
