| St. Charles | |
|
4757 N 76th St Milwaukee WI 53218-4732 | |
| (414) 358-4145 | |
| (414) 358-5002 |
| Full Name | St. Charles |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4757 N 76th St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Katherine Anna Dibb (SUBSTANCE ABUSE COUNSELOR) |
| Authorized Official Contact | 4143585381 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Charles 4757 N 76th St Milwaukee WI 53218-4732 Ph: (414) 358-4145 | St. Charles 4757 N 76th St Milwaukee WI 53218-4732 Ph: (414) 358-4145 |
| NPI Number | 1376718320 |
|---|---|
| Provider Enumeration Date | 04/29/2008 |
| Last Update Date | 04/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376718320 | NPI | - | NPPES |
| 3918300 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 15361131 (Wisconsin) | Primary |
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