Healthcare Provider Details

I. General information

NPI: 1427775840
Provider Name (Legal Business Name): WISCONSIN ANXIETY AND DEPRESSION CLINIC, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W NORTH SHORE DR STE 101
HARTLAND WI
53029-8365
US

IV. Provider business mailing address

515 W NORTH SHORE DR STE 101
HARTLAND WI
53029-8365
US

V. Phone/Fax

Practice location:
  • Phone: 262-682-3147
  • Fax:
Mailing address:
  • Phone: 262-682-3147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW STEPHEN BAILEY
Title or Position: FOUNDER
Credential: LCSW
Phone: 262-682-3147