=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609027887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHOLIC CHARITIES, INC. ROMAN CATHOLIC DIOCESE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2008
-----------------------------------------------------
Last Update Date | 02/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2020 E MILWAUKEE ST #9
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53545-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-752-4906
-----------------------------------------------------
Fax | 608-752-9699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2020 E MILWAUKEE ST #9
-----------------------------------------------------
City | JANESVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53545-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-752-4906
-----------------------------------------------------
Fax | 608-752-9699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | KATHY STELLRECHT
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 608-821-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 7234-123
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------