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General NPI Number Information
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NPI Number | 1386969723
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF WISCONSIN AND UPPER MICHIGAN, INC.
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 411 N BRIDGE ST
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City | CHIPPEWA FALLS
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State | WI
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Zip | 54729-2504
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Country | US
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Telephone | 833-420-1103
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Fax |
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Provider Business Mailing Address
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Address Line | 6737 W WASHINGTON ST STE 2275
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City | WEST ALLIS
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State | WI
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Zip | 53214-5666
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Country | US
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Telephone | 414-246-2300
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Fax |
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Authorized Official
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Title or Position | COO
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Name | TARA TREGLOWNE
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Credential |
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Telephone | 414-246-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13165
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2872
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License Number State | WI
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