Provider Demographics
NPI:1265677884
Name:FAMILY SERVICES OF WAUKESHA
Entity Type:Organization
Organization Name:FAMILY SERVICES OF WAUKESHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-547-5567
Mailing Address - Street 1:101 W BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4833
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:
Practice Address - Street 1:101 W BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4833
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4087-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health