# WILLOW CREEK RANCH, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417334988
- **Authorized official:** JENNIFER S. PAPE REGISTERED INSTRUCTO (FOUNDER/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (414) 791-2509

## Contact information

- **Practice address:** 7404 NORTHWEST HWY \# 83, MUKWONAGO, WI 53149-8903
- **Practice address phone:** (414) 791-2509
- **Mailing address:** 7404 NORTHWEST HWY \# 83, MUKWONAGO, WI 53149-8903
- **Mailing address phone:** (414) 791-2509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | 091707 | WI | Yes |

## Other

- **Enumeration date:** 05/04/2015
- **Last updated:** 05/05/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 091707 | — | WI |