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380 S Townline Rd Wautoma WI 54982-6900 | |
(920) 787-6550 | |
(920) 787-0421 |
Full Name | |
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Speciality | Community/behavioral Health |
Location | 380 S Townline Rd, Wautoma, Wisconsin |
Authorized Official Name and Position | Jen Gonzales (ACCOUNT CLERK) |
Authorized Official Contact | 9207876550 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 1230 Wautoma WI 54982-1230 Ph: (920) 787-6618 | 380 S Townline Rd Wautoma WI 54982-6900 Ph: (920) 787-6550 |
NPI Number | 1831364926 |
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Provider Enumeration Date | 04/29/2008 |
Last Update Date | 11/07/2024 |
Certification Date | 11/07/2024 |
Identifier | Type | State | Issuer |
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1831364926 | NPI | - | NPPES |
32976900 | Medicaid | WI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 1980 (Wisconsin) | Primary |