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Organization
WILLOW CREEK RANCH, INC.
Active
Organization
WILLOW CREEK RANCH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER S. PAPE REGISTERED INSTRUCTO (FOUNDER/EXECUTIVE DIRECTOR)
(414) 791-2509
Entity
Organization
Contact information
Practice address
7404 NORTHWEST HWY # 83, MUKWONAGO, WI 53149-8903
(414) 791-2509
Mailing address
7404 NORTHWEST HWY # 83, MUKWONAGO, WI 53149-8903
(414) 791-2509
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
091707
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091707
—
WI
Enumeration date
05/04/2015
Last updated
05/05/2015
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