Provider Demographics
NPI:1235293077
Name:LAFAYETTE COUNTY
Entity Type:Organization
Organization Name:LAFAYETTE COUNTY
Other - Org Name:LAFAYETTE COUNTY HEALTH DEPARTMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEGENTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:608-776-4895
Mailing Address - Street 1:729 CLAY STREET
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1225
Mailing Address - Country:US
Mailing Address - Phone:608-776-4895
Mailing Address - Fax:608-776-4885
Practice Address - Street 1:729 CLAY STREET
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1225
Practice Address - Country:US
Practice Address - Phone:608-776-4895
Practice Address - Fax:608-776-4885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41853400Medicaid
WI44013800Medicaid
WI41853400Medicaid