Healthcare Provider Details

I. General information

NPI: 1376563593
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST STE 2275
MILWAUKEE WI
53214-5666
US

IV. Provider business mailing address

PO BOX 1462
WAUKESHA WI
53187-1462
US

V. Phone/Fax

Practice location:
  • Phone: 262-443-3163
  • Fax:
Mailing address:
  • Phone: 262-443-3163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TARA TREGLOWNE
Title or Position: COO
Credential:
Phone: 414-246-2300