Healthcare Provider Details

I. General information

NPI: 1043696321
Provider Name (Legal Business Name): WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2715
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA SEMMANN
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 262-345-5560