MEDICARE: WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1760962211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC.

Provider Business Mailing Address
First Line	:	W175N11120 STONEWOOD DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-6511
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-293-9737

Provider Business Practice Location Address
First Line	:	7877 N PORT WASHINGTON RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-3132
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-293-9737

Authorized Official
Title or Position	:	INSURANCE COORDINATOR
Name	:	LINDA RANGEL
Credential	:
Telephone Number	:	262-345-5533

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	08/15/2018

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