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Organization
IMAGINE A CHILD'S CAPACITY
Active
Organization
IMAGINE A CHILD'S CAPACITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID JOHNSON CEO. (EXECUTIVE DIRECTOR.)
(608) 316-1127
Entity
Organization
Contact information
Practice address
2875 FISH HATCHERY RD, FITCHBURG, WI 53713-3114
(608) 204-6242
(608) 204-6249
Mailing address
2875 FISH HATCHERY RD, FITCHBURG, WI 53713-3114
(608) 204-6242
(608) 204-6249
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
2251P0200X
Pediatric Physical Therapist
—
—
235500000X
Speech/Language/Hearing Specialist/Technologist
—
—
235Z00000X
Speech-Language Pathologist
—
WI
253Z00000X
In Home Supportive Care Agency
—
WI
261QR0400X
Rehabilitation Clinic/Center
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41225100
—
WI
Enumeration date
09/13/2006
Last updated
03/27/2012
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