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General NPI Number Information
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NPI Number | 1811475999
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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 | 08/01/2018
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 45638 561ST AVE
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City | NEW ULM
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State | MN
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Zip | 56073-5507
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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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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 | INSURANCE COORDINATOR
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Name | LINDA RANGEL
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Credential |
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Telephone | 800-438-1772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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