Provider Demographics
NPI:1861655052
Name:MILWAUKEE ACADEMY OF SCIENCE
Entity Type:Organization
Organization Name:MILWAUKEE ACADEMY OF SCIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERRYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-933-0302
Mailing Address - Street 1:2000 W KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-1625
Mailing Address - Country:US
Mailing Address - Phone:414-933-0302
Mailing Address - Fax:414-933-1426
Practice Address - Street 1:2000 W KILBOURN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1625
Practice Address - Country:US
Practice Address - Phone:414-933-0302
Practice Address - Fax:414-933-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44221000Medicaid