MEDICARE: WISCONSIN COMMUNITY SERVICES INC.

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
2	291U00000X	Clinical Medical Laboratory	52D0914885	WI
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417108747
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISCONSIN COMMUNITY SERVICES INC.

Provider Business Mailing Address
First Line	:	3732 W WISCONSIN AVE
Second Line	:	SUITE 320
City	:	MILWAUKEE
State	:	WI
Zip	:	53208
Country	:	US
Telephone Number	:	414-290-0400
Fax Number	:	414-271-4605

Provider Business Practice Location Address
First Line	:	3732 W WISCONSIN AVE STE 200
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-3166
Country	:	US
Telephone Number	:	414-290-0440
Fax Number	:	414-226-0351

Authorized Official
Title or Position	:	CONTROLLER
Name	:	STEPHANIE COMPTON
Credential	:
Telephone Number	:	414-290-0420

Provider Enumeration Date	:	10/06/2008
Last Update Date	:	08/16/2024

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