Provider Demographics
NPI:1679019269
Name:WOODLAN YOUTH AND FAMILY SERVICES
Entity Type:Organization
Organization Name:WOODLAN YOUTH AND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASS. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC SAC
Authorized Official - Phone:715-202-0434
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732-0201
Mailing Address - Country:US
Mailing Address - Phone:715-202-0434
Mailing Address - Fax:
Practice Address - Street 1:20499 270TH ST.
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732-0201
Practice Address - Country:US
Practice Address - Phone:715-202-0434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3739-125OtherSTATE OF WISCONSIN LICENSINGAND REGULATION