Healthcare Provider Details

I. General information

NPI: 1366517302
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S BARSTOW ST
EAU CLAIRE WI
54701-3642
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 2275
WEST ALLIS WI
53214-5666
US

V. Phone/Fax

Practice location:
  • Phone: 833-420-1103
  • Fax:
Mailing address:
  • Phone: 414-246-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: TARA TREGLOWNE
Title or Position: COO
Credential:
Phone: 414-246-2300