| NPI | 1689371049 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRICA VAUGHAN Pediatric Nurse Practitioner 262-307-1319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-02-15 |