Healthcare Provider Details

I. General information

NPI: 1588631691
Provider Name (Legal Business Name): COUNTY OF WAUPACA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HARDING ST
WAUPACA WI
54981-2012
US

IV. Provider business mailing address

811 HARDING ST
WAUPACA WI
54981-2012
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-6300
  • Fax: 715-258-6409
Mailing address:
  • Phone: 715-258-6300
  • Fax: 715-258-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1977
License Number StateWI

VIII. Authorized Official

Name: MARY SOLHEIM
Title or Position: DIRECTOR
Credential:
Phone: 715-258-6300