Provider Demographics
NPI:1568404671
Name:FAMILY SERVICE AGENCY OF WAUKESHA COUNTY INC
Entity Type:Organization
Organization Name:FAMILY SERVICE AGENCY OF WAUKESHA COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF AGENCY DEVELOPMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW, LCSAC
Authorized Official - Phone:262-547-5567
Mailing Address - Street 1:2727 N GRANDVIEW BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-547-5567
Mailing Address - Fax:262-547-1608
Practice Address - Street 1:2727 N GRANDVIEW BLVD
Practice Address - Street 2:STE 205, STE 200
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:262-547-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42158300Medicaid
WI000084930Medicare ID - Type Unspecified
WI42158300Medicaid