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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