Healthcare Provider Details

I. General information

NPI: 1841118585
Provider Name (Legal Business Name): TRAVIS SCOTT DEWITT CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 S BARSTOW ST
EAU CLAIRE WI
54701-3678
US

IV. Provider business mailing address

306 S BARSTOW ST
EAU CLAIRE WI
54701-3678
US

V. Phone/Fax

Practice location:
  • Phone: 715-225-1368
  • Fax:
Mailing address:
  • Phone: 715-225-1368
  • Fax: 715-839-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: