| NPI | 1578867107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA A NOFFSINGER Psychotherapist 262-781-1976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: WI 1861-123) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: WI 1861-123) |
| 305R00000X Preferred Provider Organization (Licence: WI 1861-123) | |
| 305S00000X Point of Service (Licence: WI 1861-123) | |
| Enumeration Date | 2010-12-21 |
| Last Update Date | 2010-12-21 |