Organization
NORTHEAST WISCONSIN WELLNESS ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE MOGA ROACH LCSW (OWNER)
(920) 766-5040
Entity
Organization
Contact information
Practice address
1941 LEHRER LN, KAUKAUNA, WI 54130-7704
(920) 766-5040
(920) 497-3135
Mailing address
1941 LEHRER LN, KAUKAUNA, WI 54130-7704
(920) 766-5040
(920) 497-3135
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
02/19/2024
Last updated
02/19/2024
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