Healthcare Provider Details

I. General information

NPI: 1508840844
Provider Name (Legal Business Name): COUNTY OF WOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N CHESTNUT AVE
MARSHFIELD WI
54449-1449
US

IV. Provider business mailing address

1600 N CHESTNUT AVE
MARSHFIELD WI
54449-1449
US

V. Phone/Fax

Practice location:
  • Phone: 715-384-2188
  • Fax: 715-387-1533
Mailing address:
  • Phone: 715-384-2188
  • Fax: 715-387-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1709
License Number StateWI

VIII. Authorized Official

Name: MARISSA KORNACK
Title or Position: FACILITY ADMINISTRATOR
Credential:
Phone: 715-384-2188