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Organization
RAVENSWOOD CLINIC INC
Active
Organization
RAVENSWOOD CLINIC INC
Active
Other names
Ravenswood Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY FRANCIS WERTH JR. MS (EXECUTIVE DIRECTOR)
(414) 224-0492
Entity
Organization
Contact information
Practice address
2266 N PROSPECT AVE, SUITE 608, MILWAUKEE, WI 53202-6306
(414) 224-0492
(414) 224-8112
Mailing address
2266 N PROSPECT AVE, SUITE 326, MILWAUKEE, WI 53202-6306
(414) 224-0492
(414) 224-8112
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2118
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L12215600
—
WI
Enumeration date
10/19/2006
Last updated
03/27/2014
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