Provider Demographics
NPI:1306305941
Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Entity type:Organization
Organization Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:REUTEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-7615
Mailing Address - Street 1:9000 W WISCONSIN AVE # MS 958
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-7615
Mailing Address - Fax:414-266-6238
Practice Address - Street 1:W11109 ROGERS RD
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-6051
Practice Address - Country:US
Practice Address - Phone:715-284-3001
Practice Address - Fax:715-284-3005
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-13
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1186OtherLICENSE