Organization
NORTHWEST WISCONSIN COMMUNITY SERVICES AGENCY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ELIZABETH MAHAN RD, CLE (WIC PROGRAM DIRECTOR)
(715) 394-2750
Entity
Organization
Contact information
Practice address
1805 N 14TH ST STE 4, SUPERIOR, WI 54880-8802
(715) 394-2750
(715) 394-4651
Mailing address
1805 N 14TH ST STE 4, SUPERIOR, WI 54880-8802
(715) 394-2750
(715) 394-4651
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44012100
—
WI
Enumeration date
08/14/2007
Last updated
09/20/2011
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