Provider Demographics
NPI:1598853020
Name:COUNTY OF DODGE
Entity Type:Organization
Organization Name:COUNTY OF DODGE
Other - Org Name:DODGE COUNTY HUMAN SERVICES DD SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-386-3534
Mailing Address - Street 1:199 COUNTY ROAD DF 3RD FLOOR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9512
Mailing Address - Country:US
Mailing Address - Phone:920-386-4094
Mailing Address - Fax:920-386-3812
Practice Address - Street 1:199 COUNTY ROAD DF 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9512
Practice Address - Country:US
Practice Address - Phone:920-386-4094
Practice Address - Fax:920-386-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1282251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43071700Medicaid