Healthcare Provider Details

I. General information

NPI: 1407988892
Provider Name (Legal Business Name): WAUKESHA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 AIRPORT RD
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: 262-548-7950
  • Fax: 262-896-8046
Mailing address:
  • Phone: 262-548-7399
  • Fax: 262-970-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number524026
License Number StateWI

VIII. Authorized Official

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