| NPI | 1275650350 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKIE J MAURER Billing Office Supervisor 715-327-4322 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WI 2404) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2015-11-23 |