| NPI | 1144593815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANYA M STAMPS CFO 414-672-1353 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: WI 1507-800) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 104100000X Social Worker | |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 207V00000X Obstetrics & Gynecology | |
| 208000000X Pediatrics | |
| 225100000X Physical Therapist | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 367A00000X Advanced Practice Midwife | |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2024-09-26 |