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General NPI Number Information
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NPI Number | 1992979769
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Entity Type | Organization
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Legal Business Name | CHILDREN'S SERVICE SOCIETY OF WISCONSIN
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 04/14/2008
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Provider Practice Location Address
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Address Line | 601 S 8TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4405
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Country | US
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Telephone | 920-458-5062
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Fax | 920-451-3941
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Provider Business Mailing Address
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Address Line | 601 S 8TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53081-4405
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Country | US
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Telephone | 920-458-5062
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Fax | 920-451-3941
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | DR. RON PUPP
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Credential | PHD
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Telephone | 414-231-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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