Healthcare Provider Details

I. General information

NPI: 1548412836
Provider Name (Legal Business Name): CHN COMMUNITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEMORIAL DR
BERLIN WI
54923-1243
US

IV. Provider business mailing address

358 E. NOYES ST.
BERLIN WI
54923-1243
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-5534
  • Fax:
Mailing address:
  • Phone: 920-361-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. ASHLEY RAE GONYO
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS
Phone: 920-290-2223