Healthcare Provider Details

I. General information

NPI: 1063964591
Provider Name (Legal Business Name): WISCONSIN LUTHERAN CHILD & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W DOUGLAS AVE
MILWAUKEE WI
53209-3529
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR ATTN: LINDA RANGEL
GERMANTOWN WI
53022-6511
US

V. Phone/Fax

Practice location:
  • Phone: 800-438-1772
  • Fax: 262-293-9737
Mailing address:
  • Phone: 800-438-1772
  • Fax: 262-293-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17655-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2449-226
License Number StateWI

VIII. Authorized Official

Name: LINDA RANGEL
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 262-345-5533