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General NPI Number Information
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NPI Number | 1437394913
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Entity Type | Organization
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Legal Business Name | COUNTY OF BURNETT
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 09/22/2011
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Provider Practice Location Address
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Address Line | 7410 COUNTY ROAD K SUITE 280
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City | SIREN
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State | WI
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Zip | 54872-9070
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Country | US
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Telephone | 715-349-7600
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Fax | 715-349-2145
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Provider Business Mailing Address
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Address Line | 7410 COUNTY ROAD K SUITE 280
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City | SIREN
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State | WI
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Zip | 54872-9070
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Country | US
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Telephone | 715-349-7600
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Fax | 715-349-2145
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. JUDY L CORNELISON
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Credential |
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Telephone | 715-349-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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