MEDICARE: WILLOW WAY COUNSELING CENTER 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1891562823
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW WAY COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	20 E MILWAUKEE ST STE 211
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3061
Country	:	US
Telephone Number	:	608-449-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 E MILWAUKEE ST STE 211
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3061
Country	:	US
Telephone Number	:	608-449-2356
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	JAMIE SWENSON
Credential	:	LCSW
Telephone Number	:	608-931-6771

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	10/16/2024

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