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Organization
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Active
Organization
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Active
Parent organization
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Other names
CHW Pain and Headache Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Authorized official
WELDON GAGE (TREASURER/CHIEF FINANCIAL OFFICER)
(414) 266-6401
Entity
Organization
Contact information
Practice address
9000 W WISCONSIN AVE, PAIN CLINIC AND HEADACHE CLINIC, MILWAUKEE, WI 53226-4874
(414) 266-3133
(414) 266-1761
Mailing address
9000 W WISCONSIN AVE, MAIL STATION 958 - SHEILA REUTEMAN, MILWAUKEE, WI 53226-4874
(414) 266-7615
(414) 266-6238
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3186-57
WI
106H00000X
Marriage & Family Therapist
662-124
WI
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275961021
—
WI
Enumeration date
10/14/2013
Last updated
09/25/2014
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