Healthcare Provider Details

I. General information

NPI: 1508960675
Provider Name (Legal Business Name): COUNTY OF WINNEBAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WASHINGTON AVE
OSHKOSH WI
54901
US

IV. Provider business mailing address

PO BOX 2187
OSHKOSH WI
54903-2187
US

V. Phone/Fax

Practice location:
  • Phone: 920-236-4700
  • Fax:
Mailing address:
  • Phone: 920-236-1193
  • Fax:

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: LOUIS W TOPEL
Title or Position: HUMAN SERVICES DIRECTOR
Credential: PSYD
Phone: 920-236-4700