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General NPI Number Information
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NPI Number | 1992106595
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Entity Type | Organization
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Legal Business Name | WADE KOSKI LLC
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 09/15/2014
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Provider Practice Location Address
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Address Line | 4402 S 68TH ST SUITE #100
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City | GREENFIELD
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State | WI
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Zip | 53220-3479
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Country | US
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Telephone | 414-467-2477
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Fax | 414-321-0552
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Provider Business Mailing Address
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Address Line | 4402 S 68TH ST SUITE #100
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City | GREENFIELD
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State | WI
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Zip | 53220-3479
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Country | US
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Telephone | 414-467-2477
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Fax | 414-321-0552
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Authorized Official
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Title or Position | MEMBER
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Name | MR. WADE KOSKI
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Credential | LCSW
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Telephone | 414-467-2477
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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