| NPI | 1194256156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN BELANGER Supervisor 715-845-3637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 18103) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-03-22 |