MEDICARE: WILLOWGLEN ACADEMY, 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	251C00000X	Developmentally Disabled Services Day Training Agency	2366	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2366	OTHER	WI	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881745776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOWGLEN ACADEMY, INC.

Provider Business Mailing Address
First Line	:	1744 N FARWELL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-1806
Country	:	US
Telephone Number	:	414-225-4460
Fax Number	:	414-225-4469

Provider Business Practice Location Address
First Line	:	3903 W LISBON AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-1835
Country	:	US
Telephone Number	:	414-342-2060
Fax Number	:	414-342-3663

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. LEONARD F DZIUBLA
Credential	:	LCSW
Telephone Number	:	414-225-4460

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1326025065 — MEDA-CARE AMBULANCE CORP
Practice Location Address:

2515 W VLIET ST
MILWAUKEE, WI
53205-1835

Practice Phone: 414-342-1148
Practice Fax: 414-342-0888

1780020461 — KIMBERLY SMILES
Practice Location Address:

1835 N MILWAUKEE AVE , CW
CHICAGO, IL
60647-6186

Practice Phone: 773-276-1047
Practice Fax:

1346104320 — THE NEW TESTAMENT ADULT GROUP HOME LLC
Practice Location Address:

3414 W STATE ST
MILWAUKEE, WI
53208-3357

Practice Phone: 414-801-7115
Practice Fax:

1447961123 — MR. JUAN CORRAL JR. M.S., LPC
Practice Location Address:

5508 W VLIET ST
MILWAUKEE, WI
53208-2120

Practice Phone: 262-450-5767
Practice Fax:

1326938317 — OPEN HEARTS
Practice Location Address:

1148 N 45TH ST
MILWAUKEE, WI
53208-2733

Practice Phone: 414-614-9692
Practice Fax:

1770446718 — NUMBER OF THIS NOTICE: CP 575 G BLESSED N BEAUTIFUL BEGINNINGS PRENATAL CARE LLC
Practice Location Address:

4107 W NORTH AVE
MILWAUKEE, WI
53208-1320

Practice Phone: 414-736-2682
Practice Fax:

Directions to “WILLOWGLEN ACADEMY, INC. ” 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.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.