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Organization
FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Active
Organization
FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NED DANIELS (TRIBAL CHAIRMAN)
(715) 478-4824
Entity
Organization
Contact information
Practice address
8201 MISH KO SWEN DR, CRANDON, WI 54520-8631
(715) 478-4300
(715) 478-4490
Mailing address
PO BOX 396, 8201 MISH KO SWEN DRIVE, CRANDON, WI 54520-0396
(715) 478-4300
(715) 478-4490
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42182600
—
WI
Enumeration date
08/24/2006
Last updated
12/09/2020
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