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General NPI Number Information
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NPI Number | 1932625357
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Entity Type | Organization
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Legal Business Name | REFRESH MIDWEST OPERATIONS, SC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 05/08/2018
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Provider Practice Location Address
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Address Line | 2501 HANLEY RD STE 202
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City | HUDSON
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State | WI
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Zip | 54016-8705
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Country | US
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Telephone | 715-381-1980
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Fax | 715-381-1906
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Provider Business Mailing Address
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Address Line | 2501 HANLEY RD STE 202
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City | HUDSON
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State | WI
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Zip | 54016-8705
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Country | US
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Telephone | 715-381-1980
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Fax | 715-381-1906
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | AUDREY NEVINS
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Credential | MS, LPC
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Telephone | 715-381-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1436-057
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License Number State | WI
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