Healthcare Provider Details

I. General information

NPI: 1154663375
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: 03/26/2013
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CRANSTON RD
BELOIT WI
53511-2544
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 2275
WEST ALLIS WI
53214-5666
US

V. Phone/Fax

Practice location:
  • Phone: 833-420-1103
  • Fax: 608-752-9788
Mailing address:
  • Phone: 414-246-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2872
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2872
License Number StateWI

VIII. Authorized Official

Name: TARA TREGLOWNE
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 414-246-2300