Provider Demographics
NPI:1700969334
Name:WASHINGTON COUNTY COMMUNITY SERVICES
Entity Type:Organization
Organization Name:WASHINGTON COUNTY COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN. SERVICES DIV MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-430-6474
Mailing Address - Street 1:14949 62ND ST N RM 200
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14949 62ND ST N RM 200
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6132
Practice Address - Country:US
Practice Address - Phone:651-430-6474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management