| NPI | 1700931300 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANNON WILBER Executive Director 715-799-3861 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WI 2228) |
| Additional Taxonomies | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2022-12-28 |