Provider Demographics
NPI:1134668049
Name:TAYLOR COUNTY HUMAN SERVICES DEPARTMENT
Entity Type:Organization
Organization Name:TAYLOR COUNTY HUMAN SERVICES DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPURTY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-748-3332
Mailing Address - Street 1:540 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-2027
Mailing Address - Country:US
Mailing Address - Phone:715-748-3332
Mailing Address - Fax:715-748-3342
Practice Address - Street 1:540 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-2027
Practice Address - Country:US
Practice Address - Phone:715-748-3332
Practice Address - Fax:715-748-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42140500Medicaid