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Organization
NORTHWEST COUNSELING AND GUIDANCE CLINIC- SIREN DAY TREATMENT
Active
Organization
NORTHWEST COUNSELING AND GUIDANCE CLINIC- SIREN DAY TREATMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE MAURER (OFFICE SUPERVISOR)
(715) 349-7069
Entity
Organization
Contact information
Practice address
24996 ST RD 35, SIREN, WI 54872-9239
(715) 349-7069
(888) 625-8634
Mailing address
PO BOX 309, SIREN, WI 54872-0309
(715) 349-7069
(888) 625-8634
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
2290
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42626
HEALTH PARTNERS
MN
05
—
43004000
—
WI
01
—
7H956NO
BCBS OF MN
MN
01
—
HUMANA
HUMANA
—
01
—
PREFERRED ONE
PREFERRED ONE
MN
01
—
VALUE OPTIONS
VALUE OPTIONS
—
Enumeration date
03/26/2007
Last updated
03/02/2020
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