Organization
WELLPOINT CARE NETWORK
Active
Other names
SaintA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JODY ANN PAHLAVAN PSY.D. (VICE PRESIDENT OF CLINICAL SERVICES)
(414) 463-1880
Entity
Organization
Contact information
Practice address
8901 W. CAPITOL DR, MILWAUKEE, WI 53222-1706
(414) 465-5751
(414) 463-2770
Mailing address
8901 W. CAPITOL DR, MILWAUKEE, WI 53222-1706
(414) 465-5751
(414) 463-2770
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
WI
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100078122
—
WI
05
—
43016900
—
WI
Enumeration date
04/15/2008
Last updated
04/06/2023
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