Provider Demographics
NPI:1649339813
Name:MILWAUKEE ACADEMY
Entity type:Organization
Organization Name:MILWAUKEE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-257-3141
Mailing Address - Street 1:9501 W WATERTOWN PLANK RD
Mailing Address - Street 2:PO BOX 13397
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3552
Mailing Address - Country:US
Mailing Address - Phone:414-257-3141
Mailing Address - Fax:414-257-3151
Practice Address - Street 1:9501 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3552
Practice Address - Country:US
Practice Address - Phone:414-257-3141
Practice Address - Fax:414-257-3151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children