Provider Demographics
NPI:1417142928
Name:OZAUKEE COUNTY PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:OZAUKEE COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, CPH, CHES
Authorized Official - Phone:262-284-8170
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:121 W MAIN STREET
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-1813
Mailing Address - Country:US
Mailing Address - Phone:262-284-8170
Mailing Address - Fax:262-284-8105
Practice Address - Street 1:121 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074
Practice Address - Country:US
Practice Address - Phone:262-284-8170
Practice Address - Fax:262-284-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43085500Medicaid