Provider Demographics
NPI:1922473693
Name:INTERACT CENTERS OF WISCONSIN INC
Entity Type:Organization
Organization Name:INTERACT CENTERS OF WISCONSIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDLOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-468-7228
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-0555
Mailing Address - Country:US
Mailing Address - Phone:844-468-7228
Mailing Address - Fax:715-598-6175
Practice Address - Street 1:903 BOYCE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3836
Practice Address - Country:US
Practice Address - Phone:844-468-7228
Practice Address - Fax:715-598-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty