Provider Demographics
NPI:1366431173
Name:COUNTY OF KEWAUNEE
Entity type:Organization
Organization Name:COUNTY OF KEWAUNEE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANNOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-388-7030
Mailing Address - Street 1:810 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216-1140
Mailing Address - Country:US
Mailing Address - Phone:920-388-7030
Mailing Address - Fax:920-388-7044
Practice Address - Street 1:810 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216-1140
Practice Address - Country:US
Practice Address - Phone:920-388-7030
Practice Address - Fax:920-388-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2288261QR0405X
WI1466261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43423600Medicaid
WI32979271OtherMA CRISIS INTERVENTION
WI41225200OtherMA PT OT
WI42140100Medicaid
WI42551900OtherMA ST
WI43073100Medicaid
WI42140100Medicaid
WI42551900OtherMA ST