Healthcare Provider Details

I. General information

NPI: 1659561413
Provider Name (Legal Business Name): BROADSTEP-WISCONSIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6414 W FOND DU LAC AVE
MILWAUKEE WI
53218-4917
US

IV. Provider business mailing address

6414 W FOND DU LAC AVE
MILWAUKEE WI
53218-4917
US

V. Phone/Fax

Practice location:
  • Phone: 414-463-8777
  • Fax: 414-463-1668
Mailing address:
  • Phone: 414-463-8777
  • Fax: 414-463-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JULIANNE YOPPS
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 414-930-4421