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General NPI Number Information
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NPI Number | 1417120478
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Entity Type | Organization
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Legal Business Name | COUNTY OF WAUSHARA
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 380 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6900
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Country | US
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Telephone | 920-787-6550
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Fax | 920-787-0421
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Provider Business Mailing Address
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Address Line | 380 S TOWNLINE RD
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City | WAUTOMA
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State | WI
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Zip | 54982-6900
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Country | US
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Telephone | 920-787-6550
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Fax | 920-787-0421
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Authorized Official
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Title or Position | ACCOUNT CLERK
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Name | JEN GONZALES
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Credential |
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Telephone | 920-787-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 1980
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License Number State | WI
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