Healthcare Provider Details

I. General information

NPI: 1407271695
Provider Name (Legal Business Name): DRIFTLESS RECOVERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2014
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 MAIN ST SUITE 301
LA CROSSE WI
54601-3261
US

IV. Provider business mailing address

114 VERNON ST
WESTBY WI
54667-1122
US

V. Phone/Fax

Practice location:
  • Phone: 608-386-6154
  • Fax:
Mailing address:
  • Phone: 608-386-6154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16304-130
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12863-130
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1231-226
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27182
License Number StateWI

VIII. Authorized Official

Name: MR. BRETT A KNUTSON
Title or Position: PRESIDENT/CO-FOUNDER
Credential:
Phone: 608-519-5906