Provider Demographics
NPI:1386784742
Name:RECONNECTIONS
Entity type:Organization
Organization Name:RECONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:B.
Authorized Official - Middle Name:HAL
Authorized Official - Last Name:DESSEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC III
Authorized Official - Phone:414-221-9293
Mailing Address - Street 1:921 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6513
Mailing Address - Country:US
Mailing Address - Phone:414-221-9293
Mailing Address - Fax:414-221-9532
Practice Address - Street 1:921 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-6513
Practice Address - Country:US
Practice Address - Phone:414-221-9293
Practice Address - Fax:414-221-9532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1775261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42211500Medicaid
WI42211500Medicaid