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General NPI Number Information
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NPI Number | 1669518536
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Entity Type | Organization
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Legal Business Name | CHILD & ADOLESCENT PSYCHIATRIC SERVICES, S.C.
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8989 N. PORT WASHINGTON RD. SUITE 220
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City | MILWAUKEE
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State | WI
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Zip | 53217-1633
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Country | US
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Telephone | 414-352-3336
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Fax | 414-352-3928
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Provider Business Mailing Address
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Address Line | 8989 N. PORT WASHINGTON RD. SUITE 220
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City | MILWAUKEE
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State | WI
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Zip | 53217-1633
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Country | US
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Telephone | 414-352-3336
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Fax | 414-352-3928
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Authorized Official
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Title or Position | TREASURER
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Name | DR. RANDALL R. ROWLETT
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Credential | MD
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Telephone | 414-352-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | WI
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