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General NPI Number Information
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NPI Number | 1508671264
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Entity Type | Organization
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Legal Business Name | FORWARD WAY MENTAL HEALTH, LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 21 W NEW YORK AVE
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City | OSHKOSH
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State | WI
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Zip | 54901-3757
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Country | US
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Telephone | 414-220-0313
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 54
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City | WINNEBAGO
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State | WI
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Zip | 54985-0054
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Country | US
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Telephone | 414-220-0313
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. JENNA NELSON
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Credential | PSY.D.
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Telephone | 414-220-0313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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