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General NPI Number Information
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NPI Number | 1497029904
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Entity Type | Organization
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Legal Business Name | WIS. LUTHERAN CHILD & FAMILY SERVICES
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 2345 N 25TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53206-1003
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Country | US
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Telephone | 262-345-5560
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Fax | 262-345-5562
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 262-345-5560
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Fax | 262-345-5562
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Authorized Official
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Title or Position | PROGRAMS DIRECTOR
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Name | DANIEL P NOMMENSEN
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Credential | MA, LPC, CEAP
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Telephone | 262-345-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 7143-123
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License Number State | WI
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