Provider Demographics
NPI:1689865883
Name:ISLAMIC FAMILY & SOCIAL SERVICES, INC
Entity Type:Organization
Organization Name:ISLAMIC FAMILY & SOCIAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAHEEDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW,LMFT,CSAC
Authorized Official - Phone:414-462-4697
Mailing Address - Street 1:5150 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-5400
Mailing Address - Country:US
Mailing Address - Phone:414-462-4697
Mailing Address - Fax:414-462-8296
Practice Address - Street 1:5150 N 32ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-5400
Practice Address - Country:US
Practice Address - Phone:414-462-4697
Practice Address - Fax:414-462-8296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1443251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42189800Medicaid