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General NPI Number Information
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NPI Number | 1669923249
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Entity Type | Organization
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Legal Business Name | JOHN E ALEXANDER SOUTH WOOD COUNTY YOUNG MEN'S CHRISTIAN ASSOCIATION
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Dates
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Enumeration Date | 10/19/2016
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Last Update Date | 03/31/2017
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Provider Practice Location Address
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Address Line | 211 WISCONSIN RIVER DR
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City | PORT EDWARDS
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State | WI
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Zip | 54469-1437
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Country | US
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Telephone | 715-887-3240
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Fax | 715-887-3262
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Provider Business Mailing Address
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Address Line | 211 WISCONSIN RIVER DR
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City | PORT EDWARDS
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State | WI
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Zip | 54469-1437
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Country | US
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Telephone | 715-887-3240
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Fax | 715-887-3262
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Authorized Official
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Title or Position | FINANCE DIRECTOR
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Name | CHRISTINA CONRAD
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Credential |
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Telephone | 715-818-6016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State |
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