| NPI | 1740365378 |
|---|---|
| Doing Business As | LAKESIDE CLINIC |
| Entity Type | Organization |
| Authorized Contact | VINCENT A GRASER Clinical Social Worker 920-458-9434 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WI 1501) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-08-22 |