Healthcare Provider Details

I. General information

NPI: 1023228814
Provider Name (Legal Business Name): SIXTEENTH STREET COMMUNITY HEALTH CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 S 20TH STREET
MILWAUKEE WI
53215
US

IV. Provider business mailing address

1032 S 16TH ST SUITE 219
MILWAUKEE WI
53204
US

V. Phone/Fax

Practice location:
  • Phone: 414-672-3145
  • Fax: 414-383-5597
Mailing address:
  • Phone: 414-672-3145
  • Fax: 414-383-5597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. TANYA M STAMPS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 414-897-5407