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General NPI Number Information
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NPI Number | 1770032419
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Entity Type | Organization
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Legal Business Name | LA CROSSE AREA FAMILY YOUNG MEN'S CHRISTIAN ASSOCIATION, INC.
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Dates
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Enumeration Date | 09/22/2016
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 1140 MAIN STREET
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-782-9622
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Fax | 608-782-9616
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Provider Business Mailing Address
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Address Line | 1140 MAIN STREET
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-782-9622
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Fax | 608-782-9616
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM W. SOPER JR.
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Credential |
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Telephone | 608-782-5944
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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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