# CHILDREN'S HOSPITAL OF WISCONSIN, INC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CHILDREN'S HOSPITAL OF WISCONSIN, INC.
- **Other names:** CHW Pain and Headache Clinic
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1275961021
- **Legal business name:** CHILDREN'S HOSPITAL OF WISCONSIN, INC.
- **Authorized official:** WELDON GAGE (TREASURER/CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (414) 266-6401

## Contact information

- **Practice address:** 9000 W WISCONSIN AVE, PAIN CLINIC AND HEADACHE CLINIC, MILWAUKEE, WI 53226-4874
- **Practice address phone:** (414) 266-3133
- **Practice address fax:** (414) 266-1761
- **Mailing address:** 9000 W WISCONSIN AVE, MAIL STATION 958 - SHEILA REUTEMAN, MILWAUKEE, WI 53226-4874
- **Mailing address phone:** (414) 266-7615
- **Mailing address fax:** (414) 266-6238

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | 3186-57 | WI | — |
| 106H00000X | Marriage & Family Therapist | 662-124 | WI | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/14/2013
- **Last updated:** 09/25/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1275961021 | — | WI |