=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104930866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF ADAMS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2006
-----------------------------------------------------
Last Update Date | 12/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 108 E NORTH ST
-----------------------------------------------------
City | FRIENDSHIP
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53934-9443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-339-4505
-----------------------------------------------------
Fax | 608-339-4593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 108 E NORTH ST
-----------------------------------------------------
City | FRIENDSHIP
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53934-9443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-339-4505
-----------------------------------------------------
Fax | 608-339-4593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FISCAL MANAGER
-----------------------------------------------------
Name | WENDY PIERCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-339-4505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 1253
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------