Provider Demographics
NPI:1245347459
Name:INNER DYNAMICS
Entity type:Organization
Organization Name:INNER DYNAMICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LAU
Authorized Official - Last Name:SCHINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-276-3856
Mailing Address - Street 1:8825 S. HOWELL AVE
Mailing Address - Street 2:#305
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3762
Mailing Address - Country:US
Mailing Address - Phone:414-276-3856
Mailing Address - Fax:414-235-9139
Practice Address - Street 1:8825 S. HOWELL AVE
Practice Address - Street 2:#305
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3762
Practice Address - Country:US
Practice Address - Phone:414-276-3856
Practice Address - Fax:414-235-9139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42110400Medicaid