Healthcare Provider Details

I. General information

NPI: 1073328357
Provider Name (Legal Business Name): HEALING PATHS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STONIER LN
RIDGEWAY WI
53582-9798
US

IV. Provider business mailing address

PO BOX 7
REWEY WI
53580-0007
US

V. Phone/Fax

Practice location:
  • Phone: 608-341-8600
  • Fax:
Mailing address:
  • Phone: 608-574-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JANE ELLEN KEMNITZER
Title or Position: MEMBER
Credential: MSE LCSW
Phone: 608-574-4352