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General NPI Number Information
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NPI Number | 1750475513
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Entity Type | Organization
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Legal Business Name | WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 4351 W COLLEGE AVE SUITE 410
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City | APPLETON
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State | WI
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Zip | 54914-3928
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Country | US
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Telephone | 262-345-5599
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Fax | 262-345-5608
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Provider Business Mailing Address
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Address Line | W175N11120 STONEWOOD DR
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City | GERMANTOWN
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State | WI
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Zip | 53022-6511
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Country | US
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Telephone | 800-438-1772
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Fax | 262-345-5531
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | JENNIFER BEYER
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Credential |
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Telephone | 262-735-4976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 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 |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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