Provider Demographics
NPI:1376618157
Name:COUNTY OF PIERCE
Entity Type:Organization
Organization Name:COUNTY OF PIERCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-273-6765
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:54011-0670
Mailing Address - Country:US
Mailing Address - Phone:715-273-6770
Mailing Address - Fax:715-273-6862
Practice Address - Street 1:412 W KINNE ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:WI
Practice Address - Zip Code:54011
Practice Address - Country:US
Practice Address - Phone:715-273-6770
Practice Address - Fax:715-273-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251K00000X, 261QM0801X
WI1737251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42115600Medicaid