Healthcare Provider Details

I. General information

NPI: 1568645604
Provider Name (Legal Business Name): TAYLOR COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 COLLEGE AVE
MEDFORD WI
54451-2027
US

IV. Provider business mailing address

540 COLLEGE AVE
MEDFORD WI
54451-2027
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-3332
  • Fax: 715-748-3342
Mailing address:
  • Phone: 715-748-3332
  • Fax: 715-748-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN HADY
Title or Position: DIRECTOR
Credential:
Phone: 715-748-3332