Healthcare Provider Details

I. General information

NPI: 1194081240
Provider Name (Legal Business Name): MUSIC THERAPY SERVICES OF CENTRAL WISCONSIN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1835 DEERWOOD TRL
KRONENWETTER WI
54455-8077
US

IV. Provider business mailing address

PO BOX 86
MOSINEE WI
54455-0086
US

V. Phone/Fax

Practice location:
  • Phone: 715-212-5086
  • Fax:
Mailing address:
  • Phone: 715-212-5086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number14335
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14335
License Number StateWI

VIII. Authorized Official

Name: RICHELLE KROENING
Title or Position: OWNER
Credential: MT-BC, WMTR
Phone: 715-212-5086