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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