Organization
SEE CHANGE INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHILOH JORDAN BESAW LMT (BOARD PRESIDENT)
(920) 538-6368
Entity
Organization
Contact information
Practice address
1478 KENWOOD DR STE 104, MENASHA, WI 54952-1161
(920) 538-6368
Mailing address
1477 KENWOOD DR STE 200, MENASHA, WI 54952-1160
(920) 538-6368
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
02/10/2023
Last updated
02/10/2023
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