MEDICARE: COUNTY OF WOOD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2019	WI
3	251S00000X	Community/Behavioral Health Agency
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	101YP2500X	Professional Counselor	2019	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1063638088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF WOOD

Provider Business Mailing Address
First Line	:	111 W JACKSON ST
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54495-2702
Country	:	US
Telephone Number	:	715-421-8845
Fax Number	:	715-421-2266

Provider Business Practice Location Address
First Line	:	111 W JACKSON ST
Second Line	:
City	:	WISCONSIN RAPIDS
State	:	WI
Zip	:	54495-2702
Country	:	US
Telephone Number	:	715-421-8800
Fax Number	:	715-421-2266

Authorized Official
Title or Position	:	DIRECTOR - HUMAN SERVICES
Name	:	BRANDON VRUWINK
Credential	:
Telephone Number	:	715-421-8800

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	10/10/2025

111 W JACKSON ST FL 3
WISCONSIN RAPIDS, WI
54495-2702

Practice Phone: 715-421-8951
Practice Fax: