Provider Demographics
NPI:1922173418
Name:ELMERGREEN ASSOCIATES,LLC
Entity Type:Organization
Organization Name:ELMERGREEN ASSOCIATES,LLC
Other - Org Name:ELMERGREEN ASSOCIATES,LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:ELMERGREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:715-551-7175
Mailing Address - Street 1:114 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403
Mailing Address - Country:US
Mailing Address - Phone:715-845-7175
Mailing Address - Fax:715-845-7142
Practice Address - Street 1:114 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-845-7175
Practice Address - Fax:715-845-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42177800Medicaid