Provider Demographics
NPI:1457674004
Name:LA CROSSE CENTER FOR CHILDREN AND FAMILIES, LLC
Entity Type:Organization
Organization Name:LA CROSSE CENTER FOR CHILDREN AND FAMILIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIP
Authorized Official - Middle Name:H
Authorized Official - Last Name:ZIRKEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:608-788-9941
Mailing Address - Street 1:W5927 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8451
Mailing Address - Country:US
Mailing Address - Phone:608-788-9941
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:2920 EAST AVE S
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-8231
Practice Address - Country:US
Practice Address - Phone:608-788-9941
Practice Address - Fax:608-785-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI781251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39018600Medicaid
WI39018600Medicaid