MEDICARE: WISCONSIN LUTHERAN CHILD & FAMILY SERVICE

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	101YP2500X	Professional Counselor

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	:	1316323066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN LUTHERAN CHILD & FAMILY SERVICE

Provider Business Mailing Address
First Line	:	W175N11120 STONEWOOD DR
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-6511
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-293-9737

Provider Business Practice Location Address
First Line	:	3215 N DR MARTIN LUTHER KING DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53212-1926
Country	:	US
Telephone Number	:	800-438-1772
Fax Number	:	262-293-9737

Authorized Official
Title or Position	:	OPERATIONS DIRECTOR
Name	:	ANDREA SEMMENN
Credential	:
Telephone Number	:	262-345-5560

Provider Enumeration Date	:	08/05/2015
Last Update Date	:	08/05/2015

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