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General NPI Number Information
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NPI Number | 1215056080
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Entity Type | Organization
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Legal Business Name | NEWBERRY GROUP, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 125 S MAIN ST STE. B
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City | WEST BEND
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State | WI
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Zip | 53095-3361
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Country | US
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Telephone | 262-338-1900
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Fax | 262-338-1837
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Provider Business Mailing Address
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Address Line | 125 S MAIN ST STE. B
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City | WEST BEND
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State | WI
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Zip | 53095-3361
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Country | US
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Telephone | 262-338-1900
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Fax | 262-338-1837
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | DR. GENE F BRAAKSMA
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Credential | PH,D
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Telephone | 262-338-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1236 057
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License Number State | WI
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