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General NPI Number Information
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NPI Number | 1427775840
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Entity Type | Organization
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Legal Business Name | WISCONSIN ANXIETY AND DEPRESSION CLINIC, LLC.
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 515 W NORTH SHORE DR STE 101
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City | HARTLAND
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State | WI
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Zip | 53029-8365
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Country | US
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Telephone | 262-682-3147
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Fax |
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Provider Business Mailing Address
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Address Line | 515 W NORTH SHORE DR STE 101
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City | HARTLAND
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State | WI
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Zip | 53029-8365
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Country | US
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Telephone | 262-682-3147
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW STEPHEN BAILEY
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Credential | LCSW
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Telephone | 262-682-3147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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