MEDICARE: THE PARENTING PLACE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	225X00000X	Occupational Therapist
3	235Z00000X	Speech-Language Pathologist
4	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1205306115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PARENTING PLACE

Provider Business Mailing Address
First Line	:	1500 GREEN BAY ST
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6455
Country	:	US
Telephone Number	:	608-784-8125
Fax Number	:	608-796-0098

Provider Business Practice Location Address
First Line	:	1500 GREEN BAY ST
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6455
Country	:	US
Telephone Number	:	608-784-8125
Fax Number	:	608-796-0098

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JODI WIDUCH
Credential	:
Telephone Number	:	608-784-8125

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	01/08/2019

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Directions to “THE PARENTING PLACE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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