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General NPI Number Information
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NPI Number | 1821398736
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Entity Type | Organization
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Legal Business Name | PASSAGEWAY, INC. FRS-TR
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 3246 W ROLLINGWOOD DR
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City | JANESVILLE
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State | WI
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Zip | 53545-9030
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Country | US
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Telephone | 608-563-5633
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Fax | 608-563-4122
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Provider Business Mailing Address
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Address Line | 3246 W ROLLINGWOOD DR
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City | JANESVILLE
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State | WI
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Zip | 53545-9030
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Country | US
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Telephone | 608-563-5633
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Fax | 608-563-4122
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Authorized Official
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Title or Position | PRESIDENT/ PROVIDER
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Name | KATHLEEN M MILLER
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Credential | LPC CSAC ICS
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Telephone | 608-563-5633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15139-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15375-135
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2864-125
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License Number State | WI
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