Provider Demographics
NPI:1952349573
Name:PIERCE COUNTY REPRODUCTIVE HEALTH
Entity Type:Organization
Organization Name:PIERCE COUNTY REPRODUCTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARALYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-273-6755
Mailing Address - Street 1:210 LEWIS ST
Mailing Address - Street 2:P.O. BOX 82
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2107
Mailing Address - Country:US
Mailing Address - Phone:715-425-8003
Mailing Address - Fax:715-425-8221
Practice Address - Street 1:210 LEWIS ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2107
Practice Address - Country:US
Practice Address - Phone:715-425-8003
Practice Address - Fax:715-425-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42009400Medicaid