Provider Demographics
NPI:1851418982
Name:NORTHWEST JOURNEY - EAU CLAIRE
Entity Type:Organization
Organization Name:NORTHWEST JOURNEY - EAU CLAIRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KALAMBOKIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-327-4402
Mailing Address - Street 1:3203 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6917
Mailing Address - Country:US
Mailing Address - Phone:715-552-1342
Mailing Address - Fax:715-552-1644
Practice Address - Street 1:3203 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6917
Practice Address - Country:US
Practice Address - Phone:715-552-1342
Practice Address - Fax:715-552-1644
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST COUNSELING AND GUIDANCE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2421261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43007400Medicaid
MN42626OtherHEALTH PARTNERS
MN85575OtherPREFERRED ONE