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General NPI Number Information
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NPI Number | 1497298582
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Entity Type | Organization
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Legal Business Name | WISCONSIN LUTHERAN CHILD & FAMILY SERVIC, INCE
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 11655 W MCMILLAN RD
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City | BOISE
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State | ID
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Zip | 83713-2648
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Country | US
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Telephone | 800-438-1772
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Fax | 262-293-9737
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR ATTN: LINDA RANGEL
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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 | 888-658-9522
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Fax | 262-345-5531
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | LINDA RANGEL
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Credential |
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Telephone | 262-345-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 01854
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License Number State | IA
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