Organization
FOND DU LAC CO DCP CCS PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN MCMEEN (DIRECTOR-MENTAL HEALTH & AODA)
(920) 929-3500
Entity
Organization
Contact information
Practice address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3500
Mailing address
459 E 1ST ST, FOND DU LAC, WI 54935-4505
(920) 929-3500
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41763000
—
WI
Enumeration date
04/09/2007
Last updated
08/22/2020
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