Healthcare Provider Details

I. General information

NPI: 1457525347
Provider Name (Legal Business Name): CONSUMER DIRECT FOR WISCONSIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 RYAN DR SUITE 103A
HUDSON WI
54016-7979
US

IV. Provider business mailing address

1903 S RUSSELL ST
MISSOULA MT
59801-6603
US

V. Phone/Fax

Practice location:
  • Phone: 715-381-9520
  • Fax:
Mailing address:
  • Phone: 406-532-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HOLLY STEPHENS
Title or Position: LEGAL MANAGER
Credential:
Phone: 406-532-1929