Sacred Wandering / Sacred Path Practitioners

NPI #1780240614 in Mequon, Wisconsin

Provider Information

NPI Number: 1780240614
Entity Type: Organization
Organization Name: Sacred Wandering / Sacred Path Practitioners
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: May 16, 2019
Last Updated: May 16, 2019

Practice Location

Address: 10134 N PORT WASHINGTON RD STE G
City: Mequon
State: Wisconsin
ZIP Code: 53092-5700
Phone: (414) 433-9193

Authorized Official

Name: KENNETH J NELAN, MS, LPC, NCC
Title: OWNER/PROVIDER
Phone: (414) 433-9193

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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