Organization
CHIPPEWA VALLEY TECHNICAL COLLEGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELLY OLSON MS (CAMPUS ADMINISTRATOR)
(715) 833-6675
Entity
Organization
Contact information
Practice address
620 W CLAIREMONT AVE, HEC 120, EAU CLAIRE, WI 54701-6120
(715) 833-6271
(715) 833-6447
Mailing address
620 W. CLARIEMONT AVE, HEC 120, EAU CLAIRE, WI 54701
(715) 833-6271
(715) 833-6447
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38394300
BADGER CARE
WI
Enumeration date
01/19/2007
Last updated
04/19/2013
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