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General NPI Number Information
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NPI Number | 1053586412
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Entity Type | Organization
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Legal Business Name | RUSK COUNTY CSP
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 219 W 2ND ST NORTH
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City | LADY SMITH
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State | WI
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Zip | 54848
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Country | US
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Telephone | 715-532-5940
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Fax | 715-532-5947
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Provider Business Mailing Address
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Address Line | 219 W 2ND ST NORTH
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City | LADYSMITH
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State | WI
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Zip | 54848
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Country | US
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Telephone | 715-532-5940
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Fax | 715-532-5947
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | MS. PAMELA OLSON
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Credential | LICENSED CLINCAL SOC
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Telephone | 715-532-5940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WI
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