Healthcare Provider Details

I. General information

NPI: 1962676734
Provider Name (Legal Business Name): CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 N COMMERCIAL ST SUITE 400
NEENAH WI
54956-2665
US

IV. Provider business mailing address

325 N COMMERCIAL ST SUITE 400
NEENAH WI
54956-2665
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-5320
  • Fax: 920-969-7975
Mailing address:
  • Phone: 920-969-5320
  • Fax: 920-969-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RON PUPP
Title or Position: DIRECTOR OF COUNSELING
Credential: PHD
Phone: 414-231-4808