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General NPI Number Information
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NPI Number | 1376305219
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Entity Type | Organization
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Legal Business Name | RED CEDAR PSYCHOLOGY LLC
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 3120 SCHNEIDER AVE SE STE 606
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City | MENOMONIE
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State | WI
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Zip | 54751-2591
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Country | US
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Telephone | 715-505-6105
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Fax |
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Provider Business Mailing Address
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Address Line | E5948 510TH AVE
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City | MENOMONIE
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State | WI
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Zip | 54751-5610
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Country | US
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Telephone | 715-505-6105
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ERIN KAY MABRY-HILLESHIEM
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Credential | MS
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Telephone | 715-505-6105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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