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1306959515

NPI Code Detail

MEDICARE: THEDACARE, INCORPORATED

MEDICARE: THEDACARE, INCORPORATED

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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	103G00000X	Clinical Neuropsychologist
4	106H00000X	Marriage & Family Therapist
5	103T00000X	Psychologist
6	104100000X	Social Worker
7	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306959515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEDACARE, INCORPORATED

Provider Business Mailing Address
First Line	:	3 NEENAH CTR
Second Line	:
City	:	NEENAH
State	:	WI
Zip	:	54956-3070
Country	:	US
Telephone Number	:	920-830-5900
Fax Number	:	920-830-5910

Provider Business Practice Location Address
First Line	:	1095 MIDWAY RD
Second Line	:
City	:	MENASHA
State	:	WI
Zip	:	54952-1115
Country	:	US
Telephone Number	:	920-720-2300
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WILLIAM FLETT
Credential	:
Telephone Number	:	920-454-4013

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	01/02/2024

Similar Medicare Providers

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1982674081 — PAUL C BURNEY MD
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1881620722 — SANDRA GROENEWOLD MD
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Practice Fax:

1093744666 — KRISTEN E OWENS MA,LPC
Practice Location Address:

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1992802888 — JULIE A FEIDER MSE, LPC
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Directions to “THEDACARE, INCORPORATED ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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