Organization
BRIDGE THE GAP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY LINN LALUZERNE (PRESIDENT)
(715) 526-3791
Entity
Organization
Contact information
Practice address
1415 E GREEN BAY ST, SUITE 111, SHAWANO, WI 54166-3879
(715) 526-3791
(715) 526-5537
Mailing address
1415 E GREEN BAY ST, SUITE 111, SHAWANO, WI 54166-3879
(715) 526-3791
(715) 526-5537
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/05/2015
Last updated
05/05/2015
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