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General NPI Number Information
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NPI Number | 1215075296
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Entity Type | Organization
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Legal Business Name | NORTHLAND COMMUNITY SERVICES INC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 161 SPRING ST
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City | WESTFIELD
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State | WI
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Zip | 53964
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Country | US
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Telephone | 608-296-2139
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Fax | 608-296-1590
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Provider Business Mailing Address
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Address Line | PO BOX 248
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City | WESTFIELD
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State | WI
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Zip | 53964-0248
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Country | US
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Telephone | 608-296-2139
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Fax | 608-296-1590
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JON S MATTHEW
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Credential | PHD
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Telephone | 608-296-2139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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