Healthcare Provider Details

I. General information

NPI: 1548866528
Provider Name (Legal Business Name): WISCONSIN LUTHERAN CHILD & FAMILY SERVICE ,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E BURLEIGH ST
MILWAUKEE WI
53212-2119
US

IV. Provider business mailing address

W175N11120 STONEWOOD DR
GERMANTOWN WI
53022-4799
US

V. Phone/Fax

Practice location:
  • Phone: 800-438-1772
  • Fax: 262-345-5562
Mailing address:
  • Phone: 800-438-1772
  • Fax: 262-345-5562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BEYER
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 262-735-4976