Healthcare Provider Details

I. General information

NPI: 1346364585
Provider Name (Legal Business Name): WAUKESHA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 RIVERVIEW AVE
WAUKESHA WI
53188-3632
US

IV. Provider business mailing address

514 RIVERVIEW AVE ATTN: FISCAL DEPARTMENT
WAUKESHA WI
53188-3632
US

V. Phone/Fax

Practice location:
  • Phone: 262-896-8430
  • Fax: 262-896-8387
Mailing address:
  • Phone: 262-548-7212
  • Fax: 262-970-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number82059
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number000082059
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number41861400
License Number StateWI

VIII. Authorized Official

Name: DAVID M DEROSIER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 262-548-8431