Healthcare Provider Details

I. General information

NPI: 1629244082
Provider Name (Legal Business Name): AURORA COMMUNITY COUNSELING EMPLOYEE SUPPORT AND SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24670 STATE ROAD 35 70 SUITE 1200
SIREN WI
54872-4418
US

IV. Provider business mailing address

24670 STATE ROAD 35 70 SUITE 1200
SIREN WI
54872-4418
US

V. Phone/Fax

Practice location:
  • Phone: 715-349-7233
  • Fax: 715-349-7205
Mailing address:
  • Phone: 715-349-7233
  • Fax: 715-349-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2632
License Number StateWI

VIII. Authorized Official

Name: KELLY JOHNSON
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 715-532-9771