Healthcare Provider Details

I. General information

NPI: 1780981548
Provider Name (Legal Business Name): WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 N PORT WASHINGTON RD
MILWAUKEE WI
53212-4129
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR
GERMANTOWN WI
53022-6511
US

V. Phone/Fax

Practice location:
  • Phone: 262-345-5560
  • Fax: 262-345-5562
Mailing address:
  • Phone: 262-345-5560
  • Fax: 262-345-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12699-131
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4123-125
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2282-125
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2163-57
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1967-123
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6155-123
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7143-123
License Number StateWI
# 8
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4538-125
License Number StateWI

VIII. Authorized Official

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