=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548121874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INCONTROL WISCONSIN, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2935 S FISH HATCHERY RD # 233
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-6434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-444-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2935 S FISH HATCHERY RD # 233
-----------------------------------------------------
City | FITCHBURG
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53711-6434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-444-7777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOOKKEEPER
-----------------------------------------------------
Name | GINNY LUKKEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 608-444-7777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------