Provider Demographics
NPI:1760711121
Name:KRISS AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:KRISS AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:KRISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:608-836-5529
Mailing Address - Street 1:6702 STONEFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3875
Mailing Address - Country:US
Mailing Address - Phone:608-836-5529
Mailing Address - Fax:608-836-8059
Practice Address - Street 1:6702 STONEFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3875
Practice Address - Country:US
Practice Address - Phone:608-836-5529
Practice Address - Fax:608-836-8059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42123400Medicaid