Healthcare Provider Details

I. General information

NPI: 1790901627
Provider Name (Legal Business Name): COUNTY OF IRON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TACONITE ST STE 201
HURLEY WI
54534-1546
US

IV. Provider business mailing address

300 TACONITE ST STE 201
HURLEY WI
54534-1546
US

V. Phone/Fax

Practice location:
  • Phone: 715-561-3636
  • Fax: 715-561-2128
Mailing address:
  • Phone: 715-561-3636
  • Fax: 715-561-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2347
License Number StateWI

VIII. Authorized Official

Name: CAROLYN KOLSON-JANOV
Title or Position: DIRECTOR
Credential:
Phone: 715-561-3636