MEDICARE: POSITIVE REGARD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1124764758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE REGARD LLC

Provider Business Mailing Address
First Line	:	5045 BRIARWOOD LN
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-2183
Country	:	US
Telephone Number	:	262-909-5674
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 WASHINGTON AVE STE 201C
Second Line	:
City	:	MOUNT PLEASANT
State	:	WI
Zip	:	53406-4057
Country	:	US
Telephone Number	:	262-909-5674
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	KAYLEE P JOHNSON
Credential	:	MSW, LCSW
Telephone Number	:	262-909-5674

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	05/06/2022

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Directions to “POSITIVE REGARD LLC ” Practice Location

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