=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376647388
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOODWILL INDUSTRIES OF NORTH CENTRAL WI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 APPLETON ROAD
-----------------------------------------------------
City | MENASHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-731-6601
-----------------------------------------------------
Fax | 920-968-6977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 APPLETON ROAD
-----------------------------------------------------
City | MENASHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-731-6601
-----------------------------------------------------
Fax | 920-968-6977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | STEPHEN A WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 920-731-6601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------