| NPI | 1427410992 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY KATHRYN BOEHM MATTIA Licensed Physician 920-246-4925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WI 39641) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2016-10-04 |