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General NPI Number Information
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NPI Number | 1780444000
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Entity Type | Organization
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Legal Business Name | CLOVER FAMILY SERVICES LLC
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 23 W MILWAUKEE ST
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City | JANESVILLE
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State | WI
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Zip | 53548-2981
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Country | US
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Telephone | 608-448-6116
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Fax | 608-544-8110
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Provider Business Mailing Address
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Address Line | 21 W MILWAUKEE ST # 103
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City | JANESVILLE
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State | WI
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Zip | 53548-2911
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Country | US
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Telephone | 608-218-4462
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Fax | 608-544-8110
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Authorized Official
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Title or Position | CEO/OWNER
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Name | ASHLEE R GLOWACKI
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Credential | MA
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Telephone | 608-218-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 385HR2050X
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Taxonomy Name | Respite Care Camp
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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