Provider Demographics
NPI:1376647388
Name:GOODWILL INDUSTRIES OF NORTH CENTRAL WI
Entity Type:Organization
Organization Name:GOODWILL INDUSTRIES OF NORTH CENTRAL WI
Other - Org Name:BEYOND BOUNDARIES OF AUTISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-731-6601
Mailing Address - Street 1:1800 APPLETON ROAD
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952
Mailing Address - Country:US
Mailing Address - Phone:920-731-6601
Mailing Address - Fax:920-968-6977
Practice Address - Street 1:1800 APPLETON ROAD
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952
Practice Address - Country:US
Practice Address - Phone:920-731-6601
Practice Address - Fax:920-968-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty