Healthcare Provider Details

I. General information

NPI: 1902898406
Provider Name (Legal Business Name): CALUMET COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 COURT ST
CHILTON WI
53014-1127
US

IV. Provider business mailing address

206 COURT ST
CHILTON WI
53014-1127
US

V. Phone/Fax

Practice location:
  • Phone: 920-849-1400
  • Fax: 920-849-1468
Mailing address:
  • Phone: 920-849-1400
  • Fax: 920-849-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1120
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1120
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1120
License Number StateWI

VIII. Authorized Official

Name: MR. TODD ROMENESKO
Title or Position: COUNTY ADMINISTRATOR
Credential:
Phone: 920-849-1448