Provider Demographics
NPI:1669518536
Name:CHILD & ADOLESCENT PSYCHIATRIC SERVICES, S.C.
Entity type:Organization
Organization Name:CHILD & ADOLESCENT PSYCHIATRIC SERVICES, S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-352-3336
Mailing Address - Street 1:8989 N. PORT WASHINGTON RD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-1633
Mailing Address - Country:US
Mailing Address - Phone:414-352-3336
Mailing Address - Fax:414-352-3928
Practice Address - Street 1:8989 N. PORT WASHINGTON RD.
Practice Address - Street 2:SUITE 220
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-1633
Practice Address - Country:US
Practice Address - Phone:414-352-3336
Practice Address - Fax:414-352-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health