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General NPI Number Information
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NPI Number | 1528232386
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SERVICE SOCIETY OF WISCONSIN
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 1716 FORDEM AVE
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City | MADISON
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State | WI
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Zip | 53704-4604
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Country | US
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Telephone | 608-221-3511
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Fax | 608-221-3514
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Provider Business Mailing Address
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Address Line | 1716 FORDEM AVE
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City | MADISON
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State | WI
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Zip | 53704-4604
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Country | US
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Telephone | 608-221-3511
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Fax | 608-221-3514
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | DR. RON PUPP
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Credential | PHD
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Telephone | 414-231-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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