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371 E 1st St Fond Du Lac WI 54935-4563 | |
| (920) 907-3967 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 371 E 1st St, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Joseph R Minerath (SYSTEM DIRECTOR - GOV'T REIMB.) |
| Authorized Official Contact | 6084452411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
40 Camelot Dr Fond Du Lac WI 54935-8049 Ph: (920) 907-8201 | 371 E 1st St Fond Du Lac WI 54935-4563 Ph: (920) 907-3967 |
| NPI Number | 1760902191 |
|---|---|
| Provider Enumeration Date | 06/27/2017 |
| Last Update Date | 01/30/2025 |
| Certification Date | 01/30/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760902191 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 2226 (Wisconsin) | Primary |
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