MEDICARE: CHOSEN IMPACT YOUTH SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1245188069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHOSEN IMPACT YOUTH SERVICES

Provider Business Mailing Address
First Line	:	7321 W FLORIST AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-1849
Country	:	US
Telephone Number	:	414-807-3824
Fax Number	:

Provider Business Practice Location Address
First Line	:	7321 W FLORIST AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-1849
Country	:	US
Telephone Number	:	414-807-3824
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LILLIE JACKSON
Credential	:
Telephone Number	:	414-807-3824

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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Directions to “CHOSEN IMPACT YOUTH SERVICES ” Practice Location

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