Healthcare Provider Details

I. General information

NPI: 1871508515
Provider Name (Legal Business Name): COUNTY OF DODGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 COUNTY ROAD DF 3RD FLOOR
JUNEAU WI
53039-9512
US

IV. Provider business mailing address

199 COUNTY ROAD DF 3RD FLOOR
JUNEAU WI
53039-9512
US

V. Phone/Fax

Practice location:
  • Phone: 920-386-3500
  • Fax: 920-386-4564
Mailing address:
  • Phone: 920-386-3500
  • Fax: 920-386-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1282
License Number StateWI

VIII. Authorized Official

Name: MS. REBECCA L BELL
Title or Position: DIRECTOR
Credential: LCSW
Phone: 920-386-3534