Healthcare Provider Details

I. General information

NPI: 1437394913
Provider Name (Legal Business Name): COUNTY OF BURNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 COUNTY ROAD K SUITE 280
SIREN WI
54872-9070
US

IV. Provider business mailing address

7410 COUNTY ROAD K SUITE 280
SIREN WI
54872-9070
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-7600
  • Fax: 715-349-2145
Mailing address:
  • Phone: 715-349-7600
  • Fax: 715-349-2145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWI

VIII. Authorized Official

Name: MS. JUDY L CORNELISON
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 715-349-7600