Healthcare Provider Details

I. General information

NPI: 1396523098
Provider Name (Legal Business Name): EDGERTON HOSPITAL AND HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 N SHERMAN RD
EDGERTON WI
53534-9002
US

IV. Provider business mailing address

11101 N SHERMAN RD
EDGERTON WI
53534-9002
US

V. Phone/Fax

Practice location:
  • Phone: 608-884-3441
  • Fax:
Mailing address:
  • Phone: 608-884-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATHNRINE DOBBERPUHL
Title or Position: MEDICAL STAFF COORDINATOR/ADM ASST
Credential:
Phone: 608-884-1609