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NPI Code Detail

MEDICARE: CHILDREN'S SERVICE SOCIETY OF WISCONSIN

MEDICARE: CHILDREN'S SERVICE SOCIETY OF WISCONSIN
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
1106H00000XMarriage & Family Therapist
21041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528232386
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Provider Business Mailing Address
First Line : 1716 FORDEM AVE
Second Line :
City : MADISON
State : WI
Zip : 53704-4604
Country : US
Telephone Number : 608-221-3511
Fax Number : 608-221-3514
Provider Business Practice Location Address
First Line : 1716 FORDEM AVE
Second Line :
City : MADISON
State : WI
Zip : 53704-4604
Country : US
Telephone Number : 608-221-3511
Fax Number : 608-221-3514
Authorized Official
Title or Position : DIRECTOR OF COUNSELING
Name : DR. RON PUPP
Credential : PHD
Telephone Number : 414-231-4808
Provider Enumeration Date : 04/14/2008
Last Update Date : 11/23/2011

Similar Medicare Providers

1902644016 — ELISABETH CARTWRIGHT
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-221-3511
Practice Fax:
1174533939 — MS. CINDY S RICHGELS LCSW
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-442-4158
Practice Fax: 608-221-3514
1174535322 — MS. LISA JANINE HAJEK L.M.F.T.
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-442-4159
Practice Fax:
1437250123 — MRS. JENNIFER RUTH ZEHR MSW, LCSW
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-577-9995
Practice Fax:
1831356443 — JENNIFER L LARSON CONTI LCSW
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-221-3511
Practice Fax: 608-221-3514
1538392584 — MS. BROOKE CORLYNNE BRISCOE MFT
Practice Location Address:
1716 FORDEM AVE
MADISON, WI
53704-4604
Practice Phone: 608-221-3511
Practice Fax: 608-221-3514

Directions to “CHILDREN'S SERVICE SOCIETY OF WISCONSIN ” Practice Location

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