Provider Demographics
NPI:1205905908
Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE INC
Entity type:Organization
Organization Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE PROVIDER COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-345-5533
Mailing Address - Street 1:1049 N LYNNDALE DR
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3050
Mailing Address - Country:US
Mailing Address - Phone:920-731-9798
Mailing Address - Fax:920-731-1097
Practice Address - Street 1:757 S MAIN ST
Practice Address - Street 2:SUITE 8
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-5739
Practice Address - Country:US
Practice Address - Phone:920-731-9798
Practice Address - Fax:920-731-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42171800Medicaid