| Bridge the Gap, Inc | |
|
1415 E Green Bay St Suite 111 Shawano WI 54166-3879 | |
| (715) 526-3791 | |
| (715) 526-5537 |
| Full Name | Bridge the Gap, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1415 E Green Bay St, Shawano, Wisconsin |
| Authorized Official Name and Position | Lesley Linn Laluzerne (PRESIDENT) |
| Authorized Official Contact | 7155263791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridge the Gap, Inc 1415 E Green Bay St Suite 111 Shawano WI 54166-3879 Ph: (715) 526-3791 | Bridge the Gap, Inc 1415 E Green Bay St Suite 111 Shawano WI 54166-3879 Ph: (715) 526-3791 |
| NPI Number | 1073990420 |
|---|---|
| Provider Enumeration Date | 05/05/2015 |
| Last Update Date | 05/05/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073990420 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (NU) | Primary |
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