Provider Demographics
NPI:1548434848
Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Entity type:Organization
Organization Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR OF COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-2912
Mailing Address - Street 1:8800 WASHINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3701
Mailing Address - Country:US
Mailing Address - Phone:262-633-3591
Mailing Address - Fax:262-633-2619
Practice Address - Street 1:8800 WASHINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3701
Practice Address - Country:US
Practice Address - Phone:262-633-3591
Practice Address - Fax:262-633-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42136500Medicaid