Healthcare Provider Details

I. General information

NPI: 1447289434
Provider Name (Legal Business Name): OAKWOOD CLINICAL ASSOCIATES, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 67TH ST
KENOSHA WI
53142-3836
US

IV. Provider business mailing address

4109 67TH ST
KENOSHA WI
53142-3836
US

V. Phone/Fax

Practice location:
  • Phone: 262-652-9830
  • Fax: 262-652-2931
Mailing address:
  • Phone: 262-652-9830
  • Fax: 262-652-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateWI

VIII. Authorized Official

Name: AMY B ANDERSON
Title or Position: PSYCHOTHERAPIST
Credential: MSW
Phone: 262-652-9830