| NPI | 1750774766 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY TAXMAN Medical Director 262-241-7778 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 2428-226) |
| Enumeration Date | 2015-03-16 |
| Last Update Date | 2015-03-16 |