Organization
CHILDREN'S MEDICAL GROUP, INC.
Active
Other names
Kenosha Mental Health Walk-In Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SHEILA REUTEMAN (SR. CREDENTIALING COORDINATOR)
(414) 266-7615
Entity
Organization
Contact information
Practice address
6809 122ND AVE, KENOSHA, WI 53142-7335
(262) 891-6575
(262) 654-5467
Mailing address
9000 W WISCONSIN AVE # MS 958, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1245017201
—
WI
Enumeration date
09/13/2023
Last updated
09/13/2023
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