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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

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

General Provider Information

NPI Number	:	1730192634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Provider Business Mailing Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1599
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-2538

Provider Business Practice Location Address
First Line	:	620 S 76TH ST
Second Line	:	SUITE 120
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-1599
Country	:	US
Telephone Number	:	414-453-1400
Fax Number	:	414-453-2538

Authorized Official
Title or Position	:	INTERIM DIRECTOR OF COUNSELING
Name	:	MS. TRACY OERTER
Credential	:
Telephone Number	:	414-266-2912

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/05/2013

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