Organization
UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Active
Organization
UNIVERSITY OF WISCONSIN SYSTEM NON PAYROLL
Active
Other names
Waisman Center TIES Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH MOUNT (ASSOCIATE DEAN)
(608) 263-4938
Entity
Organization
Contact information
Practice address
122 E OLIN AVE STE 255, MADISON, WI 53713
(608) 265-9438
(608) 263-4681
Mailing address
122 E OLIN AVE STE 255, MADISON, WI 53713-1468
(608) 265-9438
(608) 263-4681
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21252100
—
WI
Enumeration date
04/04/2007
Last updated
12/04/2024
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