Organization
CENTER FOR LIFE & LOSS INTEGRATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUDITH F. KOEPPL ACSW CICSW (DIRECTOR)
(608) 258-7771
Entity
Organization
Contact information
Practice address
4123 MONONA DR, MONONA, WI 53716-1661
(608) 258-7771
(608) 832-6486
Mailing address
4123 MONONA DR, MONONA, WI 53716-1661
(608) 258-7771
(608) 832-6486
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1842123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42245700
—
WI
Enumeration date
05/11/2008
Last updated
05/11/2008
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