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General NPI Number Information
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NPI Number | 1518067974
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Entity Type | Organization
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Legal Business Name | COUNTY OF BROWN
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 3150 GERSHWIN DRIVE
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City | GREEN BAY
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State | WI
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Zip | 54311-5859
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Country | US
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Telephone | 920-391-4839
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Fax | 920-391-4870
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Provider Business Mailing Address
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Address Line | 3150 GERSHWIN DRIVE
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City | GREEN BAY
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State | WI
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Zip | 54311-5859
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Country | US
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Telephone | 920-391-4839
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Fax | 920-391-4870
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Authorized Official
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Title or Position | BEHAVIORAL HEALTH SUPERVISOR
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Name | ELIZA KILLIAN
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Credential |
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Telephone | 920-391-4816
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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 | 1117
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License Number State | WI
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