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General NPI Number Information
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NPI Number | 1669860193
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Entity Type | Organization
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Legal Business Name | COOPERATIVE EDUCATIONAL SERVICE AGENCY 2
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 17 S RIVER STREET #100
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City | JANESVILLE
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State | WI
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Zip | 53548
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Country | US
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Telephone | 608-741-6687
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Fax | 608-756-1288
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Provider Business Mailing Address
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Address Line | 1221 INNOVATION DRIVE SUITE 205
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City | WHITEWATER
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State | WI
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Zip | 53190
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Country | US
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Telephone | 262-473-1473
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Fax | 262-472-2269
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR OF OPERATIONS
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Name | NICOLE BARLASS
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Credential |
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Telephone | 262-473-1447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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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 | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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