Provider Demographics
NPI:1518010800
Name:ICF CONSULTANTS, INC.
Entity Type:Organization
Organization Name:ICF CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONJEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:414-273-2220
Mailing Address - Street 1:1524 N FARWELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2329
Mailing Address - Country:US
Mailing Address - Phone:414-273-2220
Mailing Address - Fax:414-273-2223
Practice Address - Street 1:1524 N FARWELL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2329
Practice Address - Country:US
Practice Address - Phone:414-273-2220
Practice Address - Fax:414-273-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI603124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40940200Medicaid