Provider Demographics
NPI:1821398736
Name:PASSAGEWAY, INC. FRS-TR
Entity Type:Organization
Organization Name:PASSAGEWAY, INC. FRS-TR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CSAC ICS
Authorized Official - Phone:608-563-5633
Mailing Address - Street 1:3246 W ROLLINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-9030
Mailing Address - Country:US
Mailing Address - Phone:608-563-5633
Mailing Address - Fax:608-563-4122
Practice Address - Street 1:3246 W ROLLINGWOOD DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-9030
Practice Address - Country:US
Practice Address - Phone:608-563-5633
Practice Address - Fax:608-563-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15139-132101YA0400X
WI15375-135101YA0400X
WI2864-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty