Healthcare Provider Details

I. General information

NPI: 1346233350
Provider Name (Legal Business Name): ST. CROIX TRIBAL COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

IV. Provider business mailing address

4404 STATE ROAD 70
WEBSTER WI
54893-9251
US

V. Phone/Fax

Practice location:
  • Phone: 877-455-1901
  • Fax: 715-349-8528
Mailing address:
  • Phone: 877-455-1901
  • Fax: 715-349-8528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2217
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2217
License Number StateWI

VIII. Authorized Official

Name: AMBER HEINZ
Title or Position: HEALTH DIRECTOR
Credential:
Phone: 715-349-8554