Healthcare Provider Details

I. General information

NPI: 1477468536
Provider Name (Legal Business Name): WISCONSIN BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15850 W BLUEMOUND RD STE 210
BROOKFIELD WI
53005-6008
US

IV. Provider business mailing address

1030 SE 14TH DR
DEERFIELD BEACH FL
33441-7231
US

V. Phone/Fax

Practice location:
  • Phone: 262-474-3589
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN CROALL
Title or Position: CEO
Credential:
Phone: 413-231-2523