Provider Demographics
NPI:1730928532
Name:NEW CHANGES LLC
Entity type:Organization
Organization Name:NEW CHANGES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE JO
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLESER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:920-530-4433
Mailing Address - Street 1:3311 S PACKERLAND DR
Mailing Address - Street 2:SUITE A #19
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-9539
Mailing Address - Country:US
Mailing Address - Phone:920-530-4433
Mailing Address - Fax:920-688-4261
Practice Address - Street 1:3311 S PACKERLAND DR
Practice Address - Street 2:SUITE A #19
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9539
Practice Address - Country:US
Practice Address - Phone:920-530-4433
Practice Address - Fax:920-688-4261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW CHANGES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI10021415Medicaid