Provider Demographics
NPI:1336214543
Name:INTERCONNECTIONS, SC
Entity Type:Organization
Organization Name:INTERCONNECTIONS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-654-5333
Mailing Address - Street 1:920 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4041
Mailing Address - Country:US
Mailing Address - Phone:262-654-5333
Mailing Address - Fax:262-654-7818
Practice Address - Street 1:920 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4041
Practice Address - Country:US
Practice Address - Phone:262-654-5333
Practice Address - Fax:262-654-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42133400Medicaid
WI10516OtherHEALTH EOS
WIA163335OtherVALUE OPTIONS
WI236442OtherMANAGED HEALTH NETWORK
WI42133400Medicaid
WI4496651OtherAETNA
WI117424OtherBEHAVIORAL HEALTH NETWORK
WI4496651OtherAETNA