Provider Demographics
NPI:1821262684
Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Entity Type:Organization
Organization Name:CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR OF COUNSELING
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OERTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-266-2912
Mailing Address - Street 1:8207 22ND AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6211
Mailing Address - Country:US
Mailing Address - Phone:262-652-5522
Mailing Address - Fax:262-652-7228
Practice Address - Street 1:8207 22ND AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6211
Practice Address - Country:US
Practice Address - Phone:262-652-5522
Practice Address - Fax:262-652-7228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42210200Medicaid