Provider Demographics
NPI:1962647081
Name:DEVELOPMENTAL DISABILITIES INFORMATION SERVICE, INC.
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITIES INFORMATION SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:LEONE
Authorized Official - Last Name:FELL
Authorized Official - Suffix:
Authorized Official - Credentials:CSW
Authorized Official - Phone:262-898-2100
Mailing Address - Street 1:1139 S SUNNYSLOPE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3998
Mailing Address - Country:US
Mailing Address - Phone:262-637-2707
Mailing Address - Fax:262-637-0266
Practice Address - Street 1:1139 S SUNNYSLOPE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3998
Practice Address - Country:US
Practice Address - Phone:262-637-2707
Practice Address - Fax:262-637-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management