| Jefferson County Human Services-crisis Intervention Rendering Provider | |
|
1541 Annex Rd Jefferson WI 53549-9803 | |
| (920) 674-3105 | |
| (920) 674-6113 |
| Full Name | Jefferson County Human Services-crisis Intervention Rendering Provider |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1541 Annex Rd, Jefferson, Wisconsin |
| Authorized Official Name and Position | Daniel Gebauer (DEPUTY DIRECTOR) |
| Authorized Official Contact | 9206743105 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jefferson County Human Services-crisis Intervention Rendering Provider 1541 Annex Rd Jefferson WI 53549-9803 Ph: (920) 674-3105 | Jefferson County Human Services-crisis Intervention Rendering Provider 1541 Annex Rd Jefferson WI 53549-9803 Ph: (920) 674-3105 |
| NPI Number | 1689843831 |
|---|---|
| Provider Enumeration Date | 02/21/2008 |
| Last Update Date | 08/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689843831 | NPI | - | NPPES |
| 32980900 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1449 (Wisconsin) | Primary |
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