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General NPI Number Information
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NPI Number | 1154211191
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 301 E SAINT JOSEPH ST
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City | GREEN BAY
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State | WI
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Zip | 54301-2241
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Country | US
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Telephone | 920-404-2250
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Fax | 414-307-1850
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Provider Business Mailing Address
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Address Line | 9000 W WISCONSIN AVE # MS 958
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City | MILWAUKEE
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State | WI
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Zip | 53226-4874
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Country | US
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Telephone | 414-266-7615
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Fax | 414-266-6238
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Authorized Official
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Title or Position | SR. CREDENTIALING COORDINATOR
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Name | SHEILA REUTEMAN
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Credential |
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Telephone | 414-266-7615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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Taxonomy #4
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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