MEDICARE: RAVENSWOOD CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	2118	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285716308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAVENSWOOD CLINIC INC

Provider Business Mailing Address
First Line	:	2266 N PROSPECT AVE
Second Line	:	SUITE 326
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6306
Country	:	US
Telephone Number	:	414-224-0492
Fax Number	:	414-224-8112

Provider Business Practice Location Address
First Line	:	2266 N PROSPECT AVE
Second Line	:	SUITE 608
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6306
Country	:	US
Telephone Number	:	414-224-0492
Fax Number	:	414-224-8112

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ANTHONY FRANCIS WERTH JR.
Credential	:	MS
Telephone Number	:	414-224-0492

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	03/27/2014

Similar Medicare Providers

1851247969 — PALM SALVATION SERVICES
Practice Location Address:

2266 N PROSPECT AVE STE 203
MILWAUKEE, WI
53202-6306

Practice Phone: 414-534-3061
Practice Fax:

1306959960 — DR. WARREN FREDERICK BIEL DDS
Practice Location Address:

2266 N PROSPECT AVE , STE 504
MILWAUKEE, WI
53202-6306

Practice Phone: 414-272-1066
Practice Fax: 414-272-1066

1073949954 — SARAH P LAFOLLETTE
Practice Location Address:

2266 N PROSPECT AVE STE 304
MILWAUKEE, WI
53202-6306

Practice Phone: 414-247-0801
Practice Fax: 414-247-0816

1124490925 — REANIN STONE
Practice Location Address:

2266 N PROSPECT AVE STE 304
MILWAUKEE, WI
53202-6306

Practice Phone: 414-405-0670
Practice Fax:

1457713570 — JESSE ROBERT JASTRAM LPC
Practice Location Address:

2266 N PROSPECT AVE STE 304
MILWAUKEE, WI
53202-6306

Practice Phone: 414-379-8984
Practice Fax:

1326597691 — ANA MARIA VELOZ MS
Practice Location Address:

2266 N PROSPECT AVE STE 304
MILWAUKEE, WI
53202-6306

Practice Phone: 414-491-1048
Practice Fax:

Directions to “RAVENSWOOD CLINIC INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.