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17 Forest Ave Fond Du Lac WI 54935-4155 | |
| (920) 907-0813 | |
| (920) 907-0826 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 17 Forest Ave, Fond Du Lac, Wisconsin |
| Authorized Official Name and Position | Norman Briggs (DIRECTOR OF AODA SERVICES) |
| Authorized Official Contact | 6082782300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
17 Forest Ave Fond Du Lac WI 54935-4155 Ph: (920) 907-0813 | 17 Forest Ave Fond Du Lac WI 54935-4155 Ph: (920) 907-0813 |
| NPI Number | 1982877411 |
|---|---|
| Provider Enumeration Date | 04/04/2008 |
| Last Update Date | 06/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982877411 | NPI | - | NPPES |
| 43171121 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2358 (Wisconsin) | Primary |
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