Healthcare Provider Details

I. General information

NPI: 1659821981
Provider Name (Legal Business Name): SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

IV. Provider business mailing address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

V. Phone/Fax

Practice location:
  • Phone: 715-524-6832
  • Fax:
Mailing address:
  • Phone: 715-524-6832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3157-226
License Number StateWI

VIII. Authorized Official

Name: RICK KANE
Title or Position: DIRECTOR
Credential:
Phone: 715-526-4700