MEDICARE: WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC

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	101YS0200X	School Counselor

General Provider Information

NPI Number	:	1255942850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC

Provider Business Mailing Address
First Line	:	W175N11120 STONEWOOD DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-4799
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-345-5562

Provider Business Practice Location Address
First Line	:	4809 N 60TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53218-4150
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-345-5562

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	LINDA RANGEL
Credential	:
Telephone Number	:	800-438-1772

Provider Enumeration Date	:	08/17/2020
Last Update Date	:	08/17/2020

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