Provider Demographics
NPI:1093424087
Name:WINDING RIVERS COUNSELING LLC
Entity type:Organization
Organization Name:WINDING RIVERS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEDORN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, SAC, NCC
Authorized Official - Phone:715-514-0493
Mailing Address - Street 1:4330 GOLF TER STE 207
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4688
Mailing Address - Country:US
Mailing Address - Phone:715-514-0493
Mailing Address - Fax:877-855-2504
Practice Address - Street 1:4330 GOLF TER STE 207
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4688
Practice Address - Country:US
Practice Address - Phone:715-514-0493
Practice Address - Fax:877-855-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-17
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1104585959Medicaid
WI1750928347Medicaid
WI100095629Medicaid