Healthcare Provider Details

I. General information

NPI: 1053411025
Provider Name (Legal Business Name): COUNTY OF BROWN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 GERSHWIN DRIVE
GREEN BAY WI
54311-5859
US

IV. Provider business mailing address

3150 GERSHWIN DRIVE
GREEN BAY WI
54311-5859
US

V. Phone/Fax

Practice location:
  • Phone: 920-391-4839
  • Fax: 920-391-4870
Mailing address:
  • Phone: 920-391-4839
  • Fax: 920-391-4870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number2381
License Number StateWI

VIII. Authorized Official

Name: ELIZA KILLIAN
Title or Position: BEHAVIORAL HEALTH SUPERVISOR
Credential:
Phone: 920-391-4816