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General NPI Number Information
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NPI Number | 1538165766
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Entity Type | Organization
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Legal Business Name | COUNTY OF LA CROSSE
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 300 4TH ST N FL 2
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City | LA CROSSE
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State | WI
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Zip | 54601-3228
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Country | US
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Telephone | 608-785-9850
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Fax | 608-785-9846
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Provider Business Mailing Address
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Address Line | 300 4TH ST N FL 2
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City | LA CROSSE
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State | WI
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Zip | 54601-3228
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Country | US
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Telephone | 608-785-9850
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Fax | 608-785-9846
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Authorized Official
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Title or Position | DIRECTOR
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Name | AUDRA MARTINE
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Credential |
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Telephone | 608-792-3713
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 44000400
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 41853100
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License Number State | WI
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