Provider Demographics
NPI:1457185852
Name:CHANGEQUEST, LLC
Entity type:Organization
Organization Name:CHANGEQUEST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:M FORS
Authorized Official - Last Name:SPAHR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-261-4698
Mailing Address - Street 1:11345 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092
Mailing Address - Country:US
Mailing Address - Phone:262-261-4698
Mailing Address - Fax:
Practice Address - Street 1:11345 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:262-261-4698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
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
WI1083737068OtherSELF