Healthcare Provider Details

I. General information

NPI: 1104090778
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 SHEPHERDS DR
WEST BEND WI
53090-8488
US

IV. Provider business mailing address

302 N JACKSON ST
MILWAUKEE WI
53202-5904
US

V. Phone/Fax

Practice location:
  • Phone: 262-338-1303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MARIE ODEGAARD
Title or Position: DIRECTOR, BUS OPERS.
Credential:
Phone: 414-289-3796