MEDICARE: CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	1186	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1184896920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S SERVICE SOCIETY OF WISCONSIN

Provider Business Mailing Address
First Line	:	2004 HIGHLAND AVE STE M
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-4389
Country	:	US
Telephone Number	:	715-835-5915
Fax Number	:	715-835-8112

Provider Business Practice Location Address
First Line	:	2004 HIGHLAND AVE STE M
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-4389
Country	:	US
Telephone Number	:	715-835-5915
Fax Number	:	715-835-8112

Authorized Official
Title or Position	:	AREA SUPERVISOR
Name	:	MARNIE HERSRUD
Credential	:	MSW, LCSW
Telephone Number	:	715-835-5915

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/25/2022

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Directions to “CHILDREN'S SERVICE SOCIETY OF WISCONSIN ” Practice Location

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