Organization
WILLOW TREE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB TETZLAFF (OWNER)
(920) 379-4388
Entity
Organization
Contact information
Practice address
2905 W 9TH AVE, OSHKOSH, WI 54904-6504
(920) 379-4388
Mailing address
2905 W 9TH AVE, OSHKOSH, WI 54904-6504
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
WI
Other
Enumeration date
09/17/2012
Last updated
09/17/2012
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