Healthcare Provider Details

I. General information

NPI: 1497884597
Provider Name (Legal Business Name): CHILDREN'S SERVICE SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S 24TH AVE STE 400
WAUSAU WI
54401-5242
US

IV. Provider business mailing address

705 S 24TH AVE STE 400
WAUSAU WI
54401-5242
US

V. Phone/Fax

Practice location:
  • Phone: 715-848-1457
  • Fax: 715-848-2959
Mailing address:
  • Phone: 715-848-1457
  • Fax: 715-848-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNY WALCZAK
Title or Position: DIRECTOR MBH INTEGRATION
Credential:
Phone: 414-337-6807