Healthcare Provider Details

I. General information

NPI: 1144995077
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 BROADWAY ST STE 101
BARABOO WI
53913-2488
US

IV. Provider business mailing address

727 8TH ST
BARABOO WI
53913-1794
US

V. Phone/Fax

Practice location:
  • Phone: 608-448-1011
  • Fax: 608-355-4106
Mailing address:
  • Phone: 608-448-1011
  • Fax: 608-355-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TARA TREGLOWNE
Title or Position: COO
Credential:
Phone: 414-246-2300