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General NPI Number Information
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NPI Number | 1477314854
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Entity Type | Organization
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Legal Business Name | WAUKESHA COUNTY
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 1501 AIRPORT RD
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City | WAUKESHA
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State | WI
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Zip | 53188-2461
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Country | US
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Telephone | 262-548-7950
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Fax | 262-970-6696
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Provider Business Mailing Address
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Address Line | 514 RIVERVIEW AVE
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City | WAUKESHA
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State | WI
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Zip | 53188-3631
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Country | US
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Telephone | 262-548-7666
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Fax | 262-970-6696
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DAVID M DEROSIER
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Credential |
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Telephone | 262-548-8431
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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 |
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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