Healthcare Provider Details

I. General information

NPI: 1053397869
Provider Name (Legal Business Name): EASTER SEALS SOUTHEAST WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6737 W WASHINGTON ST STE 4205
WEST ALLIS WI
53214-5662
US

IV. Provider business mailing address

6737 W WASHINGTON ST STE 4205
WEST ALLIS WI
53214-5662
US

V. Phone/Fax

Practice location:
  • Phone: 414-449-4444
  • Fax: 414-571-5568
Mailing address:
  • Phone: 414-449-4444
  • Fax: 414-571-5568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNA WAMPOLE
Title or Position: PRESIDENT
Credential:
Phone: 414-449-4444