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Organization
PREMIER MEDICAL & COUPLE THERAPY
Active
Organization
PREMIER MEDICAL & COUPLE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANINE MARIE SWENSON MD, LMFT (DIRECTOR & OWNER)
(262) 957-6159
Entity
Organization
Contact information
Practice address
1025 W GLEN OAKS LN STE 208, MEQUON, WI 53092-3374
(262) 957-6159
Mailing address
1025 W GLEN OAKS LN STE 208, MEQUON, WI 53092-3374
(262) 957-6159
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G17772
—
WI
Enumeration date
07/30/2020
Last updated
07/30/2020
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