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General NPI Number Information
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NPI Number | 1679617831
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Entity Type | Organization
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Legal Business Name | CLARK COUNTY
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 517 COURT ST ROOM #105
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City | NEILLSVILLE
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State | WI
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Zip | 54456-1971
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Country | US
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Telephone | 715-743-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 517 COURT ST ROOM #105
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City | NEILLSVILLE
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State | WI
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Zip | 54456-1971
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Country | US
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Telephone | 715-743-5105
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | ROBERT J LEISCHOW
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Credential | MPH
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Telephone | 715-743-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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