Provider Demographics
NPI:1124292420
Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Entity type:Organization
Organization Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR OF COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-2912
Mailing Address - Street 1:601 S CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-4104
Mailing Address - Country:US
Mailing Address - Phone:715-387-2729
Mailing Address - Fax:715-387-4526
Practice Address - Street 1:601 S CENTRAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-4104
Practice Address - Country:US
Practice Address - Phone:715-387-2729
Practice Address - Fax:715-387-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42202600Medicaid