Healthcare Provider Details

I. General information

NPI: 1255891933
Provider Name (Legal Business Name): EAU CLAIRE COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

IV. Provider business mailing address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKIE GARDNER
Title or Position: FISCAL SERVICES MANAGER
Credential:
Phone: 715-839-2997