Provider Demographics
NPI:1083888382
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 1:620 S 76TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1549
Mailing Address - Country:US
Mailing Address - Phone:414-453-1400
Mailing Address - Fax:414-453-2538
Practice Address - Street 1:620 S 76TH ST
Practice Address - Street 2:SUITE 120
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1549
Practice Address - Country:US
Practice Address - Phone:414-453-1400
Practice Address - Fax:414-453-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42155200Medicaid