BRIDGE THE GAP, INC (NPI# 1073990420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073990420 |
| Entity Type | Organization |
| Organization Name | BRIDGE THE GAP, INC |
| Practice Address |
1415 E Green Bay St Suite 111 Shawano WI 54166-3879 |
| Practice Telephone | 7155263791 |
| Practice Fax Number | 7155265537 |
| Mailing Telephone | 7155263791 |
| Mailing Fax Number | 7155265537 |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2015-05-05 |
| Authorized Official Name | LESLEY LINN LALUZERNE (PRESIDENT) |
| Authorized Official Telephone | 7155263791 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
1415 E GREEN BAY ST SUITE 111 |
| City | SHAWANO |
| State | WI |
| Zip Code | 54166-3879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629162771 | Elizabeth A Montour | Counselor | 1415 E Green Bay St, Ste 191, Shawano, WI 54166-3879 | 2006-10-03 |
| 1629434287 | Brittany Bartz | Behavioral Analyst | 1415 E Green Bay St, Suite 111, Shawano, WI 54166-3879 | 2016-01-12 |
| 1588020143 | Morgan Maske | Behavioral Analyst | 1415 E Green Bay St, Shawano, WI 54166-3879 | 2016-01-12 |
| 1851766281 | Lesley Kumm-laluzerne | Behavioral Analyst | 1415 E Green Bay St, Suite 111, Shawano, WI 54166-3879 | 2015-12-10 |
| 1124241724 | Fox Valley Hematology & Oncology, S.c. | Internal Medicine | 1415 E Green Bay St, Suite 141, Shawano, WI 54166-3879 | 2007-04-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641848 | Nicole Jeannine Klotzbuecher | Optometrist | 150 County Road B, Shawano, WI 54166 | 2017-07-13 |
| 1437605714 | Jennifer Marie Franke | Counselor | 504 Lakeland St, Shawano, WI 54166 | 2016-08-28 |
| 1699017913 | Benjamin D Schlais | Family Medicine | 100 County Hwy B, Shawano, WI 54166 | 2013-03-25 |
| 1154574366 | Luke T Johnson | Speech-Language Pathologist | N3684 River Road, Shawano, WI 54166 | 2008-10-31 |
| 1902054315 | Robert Joseph Bohr Jr. | Physical Therapy Assistant | N6590 Fox Lane, Shawano, WI 54166 | 2008-08-28 |
| 1790945863 | Patricia Rae Ainsworth | Physical Therapist | 1436 South Lincoln Street, Shawano, WI 54166 | 2008-06-12 |
| 1649491820 | Shawano-gresham School District | Local Education Agency (LEA) | 1050 South Union Street, Shawano, WI 54166 | 2007-05-02 |
| 1114043387 | Thomas G Peterson | Optometrist | 150a County Road B, Shawano, WI 54166 | 2007-03-21 |
| 1740343086 | John Milton Dovorany | Dentist | 1488 E Green Bay St, Shawano, WI 54166 | 2006-12-18 |
| 1265526305 | Charles E Lamarche | Counselor | 420 E Green Bay St, Ste 201, Shawano, WI 54166 | 2006-10-03 |
| Find all providers in zip 54166 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407014020 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-30 |
| 1336307008 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1750549432 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1215195987 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1174781298 | King Psychological Services | Community/Behavioral Health | 1488 E Green Bay St, Shawano, WI 54166-2258 | 2008-05-27 |
| 1558528729 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166 | 2008-05-16 |
| 1306003587 | Shawano County Department of Community Program | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-16 |
| 1497896641 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166 | 2007-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558968990 | Zoran Jovicic | Community/Behavioral Health | 3239 S 58th St Unit 104, Milwaukee, WI 53219-4365 | 2020-10-08 |
| 1437776457 | Milkweed Connections LLC | Community/Behavioral Health | 1700 Tainter St Ste D, Menomonie, WI 54751-1358 | 2020-06-26 |
| 1477178473 | Grace Counseling & Family Services S.c | Community/Behavioral Health | 121 S Adams St, New Lisbon, WI 53950-1205 | 2020-06-15 |
| 1740804491 | Strides Equestrian Therapeutic Center LLC | Community/Behavioral Health | W6769 Colby Factory Rd, Greenwood, WI 54437-9010 | 2020-05-28 |
| 1841831153 | Sheboygan County Halfway House | Community/Behavioral Health | 503 Ontario Ave, Sheboygan, WI 53081-4151 | 2019-10-08 |
| 1780234955 | Spirited Psychological Services LLC | Community/Behavioral Health | 376 Violet Cir, Grantsburg, WI 54840-8564 | 2019-09-18 |
| 1548816580 | Latara Williams | Community/Behavioral Health | 2447 N 50th St, Milwaukee, WI 53210-2815 | 2019-08-15 |
| 1942856091 | Kennedy's Circle of Wellness LLC | Community/Behavioral Health | 3614 W North Ave, Milwaukee, WI 53208-1416 | 2019-08-14 |
| 1104386101 | Counseling Center | Community/Behavioral Health | 601 N 5th St, Sheboygan, WI 53081-4624 | 2019-03-25 |
| 1205391828 | Jerome Pitchford | Community/Behavioral Health | 1220 W Atkinson Ave, Milwaukee, WI 53206-3024 | 2019-02-07 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on BRIDGE THE GAP, INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.