| Innovative Wisconsin, Llc | |
|
445 S Madison St Green Bay WI 54301-4101 | |
| (920) 431-0962 | |
| (920) 884-1967 |
| Full Name | Innovative Wisconsin, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 445 S Madison St, Green Bay, Wisconsin |
| Authorized Official Name and Position | Drue Ray (OFFICER) |
| Authorized Official Contact | 8286848441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Wisconsin, Llc 445 S Madison St Green Bay WI 54301-4101 Ph: (920) 431-0962 | Innovative Wisconsin, Llc 445 S Madison St Green Bay WI 54301-4101 Ph: (920) 431-0962 |
| NPI Number | 1871972349 |
|---|---|
| Provider Enumeration Date | 05/29/2015 |
| Last Update Date | 05/29/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871972349 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Wisconsin) | Primary |
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