Organization
CLEVELAND VA CBOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AGNES E. DEEHR (LPN)
(920) 693-5600
Entity
Organization
Contact information
Practice address
1205 NORTH AVE, CLEVELAND, WI 53015-1413
(188) 469-6614
Mailing address
336 E JEFFERSON AVE, CLEVELAND, WI 53015-1530
(920) 693-8478
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
8882-031
WI
Other
Enumeration date
07/31/2006
Last updated
08/22/2020
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