| NPI | 1225441298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MARIE BAETEN Owner/Clinical Director 920-217-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WI 7709-123) |
| Additional Taxonomies | 251S00000X (Licence: WI 2075-132) |
| 251S00000X (Licence: WI 15372-135) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2014-06-08 |