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Organization
THE REDI CLINIC OF WAUWATOSA, SC
Active
Organization
THE REDI CLINIC OF WAUWATOSA, SC
Active
Other names
Pathway Clinic, SC
Organization subpart
No
Provider details
NPI number
Authorized official
THEODORE WELTZIN MD (CO-OWNER)
(414) 727-4455
Entity
Organization
Contact information
Practice address
2500 N. MAYFAIR RD, STE 600, WAUWATOSA, WI 53226
(414) 727-4455
(414) 727-4690
Mailing address
2500 N. MAYFAIR RD, STE 600, WAUWATOSA, WI 53226
(414) 727-4455
(414) 727-4690
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1729
WI
101YM0800X
Mental Health Counselor
1729
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1043228505
—
WI
05
—
42127100
—
WI
01
—
84793
MEDICARE GROUP NUMBER
WI
Enumeration date
08/03/2006
Last updated
04/18/2017
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