Healthcare Provider Details

I. General information

NPI: 1417108747
Provider Name (Legal Business Name): WISCONSIN COMMUNITY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3732 W WISCONSIN AVE STE 200
MILWAUKEE WI
53208-3166
US

IV. Provider business mailing address

3732 W WISCONSIN AVE SUITE 320
MILWAUKEE WI
53208
US

V. Phone/Fax

Practice location:
  • Phone: 414-290-0440
  • Fax: 414-226-0351
Mailing address:
  • Phone: 414-290-0400
  • Fax: 414-271-4605

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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number52D0914885
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHANIE COMPTON
Title or Position: CONTROLLER
Credential:
Phone: 414-290-0420