Provider Demographics
NPI:1376746750
Name:MAKING CONNECTIONS
Entity Type:Organization
Organization Name:MAKING CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DIDRIKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-208-0078
Mailing Address - Street 1:W1037 ARALIA RD
Mailing Address - Street 2:
Mailing Address - City:GENOA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53128-1574
Mailing Address - Country:US
Mailing Address - Phone:262-208-0078
Mailing Address - Fax:
Practice Address - Street 1:9716 US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071-9253
Practice Address - Country:US
Practice Address - Phone:262-208-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)