Healthcare Provider Details

I. General information

NPI: 1073447884
Provider Name (Legal Business Name): FREE CLINIC OF PIERCE & ST. CROIX COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 E DIVISION ST
RIVER FALLS WI
54022-1571
US

IV. Provider business mailing address

1629 E DIVISION ST
RIVER FALLS WI
54022-1571
US

V. Phone/Fax

Practice location:
  • Phone: 715-307-3948
  • Fax: 715-307-6005
Mailing address:
  • Phone: 715-307-3948
  • Fax: 715-307-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENA MOST
Title or Position: NURSING SUPERVISOR
Credential: RN
Phone: 651-503-0639