Provider Demographics
NPI:1609992098
Name:DISCOVERY & RECOVERY CLINIC,INC.
Entity Type:Organization
Organization Name:DISCOVERY & RECOVERY CLINIC,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:KOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:414-321-4411
Mailing Address - Street 1:4402 S 68TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3479
Mailing Address - Country:US
Mailing Address - Phone:414-321-4411
Mailing Address - Fax:414-321-0552
Practice Address - Street 1:4402 S 68TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-3479
Practice Address - Country:US
Practice Address - Phone:414-321-4411
Practice Address - Fax:414-321-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1279101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42153700Medicaid
WI42153700Medicaid
WI=========014OtherBLUE CROSS & BLUE SHIELD