| Willowglen Academy Outpatient Clinic | |
|
4065 N 35th St Suite N100 Milwaukee WI 53216-1705 | |
| (414) 445-9180 | |
| (414) 445-5995 |
| Full Name | Willowglen Academy Outpatient Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 4065 N 35th St, Milwaukee, Wisconsin |
| Authorized Official Name and Position | Shanna Maloney (DIRECTOR OF OUTPATIENT SERVICES) |
| Authorized Official Contact | 4144459180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willowglen Academy Outpatient Clinic 4065 N 35th St Suite N100 Milwaukee WI 53216-1705 Ph: (414) 445-9180 | Willowglen Academy Outpatient Clinic 4065 N 35th St Suite N100 Milwaukee WI 53216-1705 Ph: (414) 445-9180 |
| NPI Number | 1619147048 |
|---|---|
| Provider Enumeration Date | 02/29/2008 |
| Last Update Date | 06/19/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619147048 | NPI | - | NPPES |
| 42167200 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2004 (Wisconsin) | Primary |
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