South Street Clinic LLC
NPI #1235128356 in Oconomowoc, Wisconsin
Provider Information
- NPI Number
- 1235128356
- Entity Type
- Organization
- Organization Name
- South Street Clinic LLC
- Primary Specialty
- Psychologist - Clinical
- Enumeration Date
- Oct 20, 2005
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 416 W SOUTH ST
- City
- Oconomowoc
- State
- Wisconsin
- ZIP Code
- 53066-2755
- Phone
- (262) 567-7673
Authorized Official
- Name
- DR. ANNE ALEXA WESTON, PHD
- Title
- CLINIC OWNER
- Phone
- (262) 567-7673
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychologist - Clinical — Clinical |
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| Joan Carol Russo, PH.D. | |
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| DR. Mia Nunez, PHD |
Organizations
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|---|---|
| A New Day Psychological Services LLC | |
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