Provider Demographics
NPI:1811101645
Name:VISION FORWARD ASSOCIATION INCORPORATED
Entity type:Organization
Organization Name:VISION FORWARD ASSOCIATION INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:414-615-0100
Mailing Address - Street 1:912 N HAWLEY RD
Mailing Address - Street 2:CHILDRENS PROGRAM
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3222
Mailing Address - Country:US
Mailing Address - Phone:414-615-0100
Mailing Address - Fax:414-238-2261
Practice Address - Street 1:912 N HAWLEY RD
Practice Address - Street 2:CHILDRENS PROGRAM
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53213-3222
Practice Address - Country:US
Practice Address - Phone:414-615-0100
Practice Address - Fax:414-238-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41201800Medicaid
WI41682200Medicaid