Provider Demographics
NPI:1588631691
Name:COUNTY OF WAUPACA
Entity Type:Organization
Organization Name:COUNTY OF WAUPACA
Other - Org Name:WAUPACA COUNTY DEPT OF HUMAN SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-258-6300
Mailing Address - Street 1:811 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2012
Mailing Address - Country:US
Mailing Address - Phone:715-258-6300
Mailing Address - Fax:715-258-6409
Practice Address - Street 1:811 HARDING ST
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2012
Practice Address - Country:US
Practice Address - Phone:715-258-6300
Practice Address - Fax:715-258-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1977101YM0800X
251K00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32977300Medicaid
WI42011200Medicaid
WI43110300Medicaid
WI44003900Medicaid
WI43077100Medicaid
WI43428000Medicaid
WI41851000Medicaid
WI42132900Medicaid
WI43110300Medicaid
WI43428000Medicaid