MEDICARE: WISCONSIN ANXIETY AND DEPRESSION CLINIC, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427775840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN ANXIETY AND DEPRESSION CLINIC, LLC.

Provider Business Mailing Address
First Line	:	515 W NORTH SHORE DR STE 101
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-8365
Country	:	US
Telephone Number	:	262-682-3147
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W NORTH SHORE DR STE 101
Second Line	:
City	:	HARTLAND
State	:	WI
Zip	:	53029-8365
Country	:	US
Telephone Number	:	262-682-3147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANDREW STEPHEN BAILEY
Credential	:	LCSW
Telephone Number	:	262-682-3147

Provider Enumeration Date	:	10/26/2022
Last Update Date	:	11/07/2025

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