Healthcare Provider Details

I. General information

NPI: 1215268552
Provider Name (Legal Business Name): COUNTY OF TREMPEALEAU TCHCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 04/15/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W20410 STATE ROAD 121
WHITEHALL WI
54773-9147
US

IV. Provider business mailing address

W20410 STATE ROAD 121
WHITEHALL WI
54773-9147
US

V. Phone/Fax

Practice location:
  • Phone: 715-538-4312
  • Fax: 715-538-2426
Mailing address:
  • Phone: 715-538-4312
  • Fax: 715-538-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000062045
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54557
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number000062045
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number950
License Number StateWI
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7026-33
License Number StateWI

VIII. Authorized Official

Name: LORI A GLAUNERT
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 715-538-4312