Provider Demographics
NPI:1922174291
Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
Entity type:Organization
Organization Name:WISCONSIN LUTHERAN CHILD & FAMILY SERVICE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE PROVIDER COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-358-7812
Mailing Address - Street 1:9555 S HOWELL AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-5000
Mailing Address - Country:US
Mailing Address - Phone:414-768-9979
Mailing Address - Fax:414-768-9981
Practice Address - Street 1:9555 S HOWELL AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-5000
Practice Address - Country:US
Practice Address - Phone:414-768-9979
Practice Address - Fax:414-768-9981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1967-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42223600Medicaid
WI42223600Medicaid