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General NPI Number Information
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NPI Number | 1770985467
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Entity Type | Organization
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Legal Business Name | NORTHWEST COUNSELING & GUIDANCE CLINIC
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Dates
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Enumeration Date | 09/24/2014
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Last Update Date | 01/15/2015
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Provider Practice Location Address
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Address Line | 16092 HIGHWAY 63
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City | HAYWARD
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State | WI
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Zip | 54843-9775
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Country | US
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Telephone | 715-699-1241
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Fax | 715-699-1243
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Provider Business Mailing Address
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Address Line | 203 UNITED WAY
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City | FREDERIC
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State | WI
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Zip | 54837-8938
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Country | US
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Telephone | 715-327-4322
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Fax | 715-327-8509
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Authorized Official
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Title or Position | BILLING OFFICE SUPERVISOR
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Name | JACKIE J MAURER
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Credential |
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Telephone | 715-327-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 3049
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License Number State | WI
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