Provider Demographics
NPI:1073787370
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:DIRECTOR OF COUNSELING
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:PUPP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:414-231-4808
Mailing Address - Street 1:223 WISCONSIN AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4968
Mailing Address - Country:US
Mailing Address - Phone:262-544-5333
Mailing Address - Fax:262-544-5393
Practice Address - Street 1:223 WISCONSIN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4968
Practice Address - Country:US
Practice Address - Phone:262-544-5333
Practice Address - Fax:262-544-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42224100Medicaid