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General NPI Number Information
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NPI Number | 1063985620
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Entity Type | Organization
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Legal Business Name | MAMMA GESE
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 01/07/2019
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Provider Practice Location Address
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Address Line | 217 N MADISON ST STE 4
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City | GREEN BAY
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State | WI
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Zip | 54301-5103
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Country | US
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Telephone | 920-228-3199
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Fax |
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Provider Business Mailing Address
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Address Line | 217 N MADISON ST STE 4
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City | GREEN BAY
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State | WI
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Zip | 54301-5103
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Country | US
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Telephone | 920-228-3199
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JESSICA KING
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Credential |
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Telephone | 920-327-9124
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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 |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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