Organization
WAUKESHA COUNTY
Active
Other names
Waukesha County (Outpatient Clinic)
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M DEROSIER (CREDENTIALING SPECIALIST)
(262) 548-8431
Entity
Organization
Contact information
Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7666
(262) 548-7656
Mailing address
514 RIVERVIEW AVE, ATTN: FISCAL DEPARTMENT, WAUKESHA, WI 53188-3632
(262) 548-7665
(262) 970-6696
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
42138400
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42138400
—
WI
Enumeration date
03/16/2007
Last updated
11/10/2025
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