Organization
KENOSHA COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELIZABETH OUIMET (CEO)
(262) 771-3561
Entity
Organization
Contact information
Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
4006 WASHINGTON RD, KENOSHA, WI 53144-4819
(262) 656-0044
(262) 764-3636
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
207Q00000X
Family Medicine Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
208D00000X
General Practice Physician
—
—
261QC1500X
Community Health Clinic/Center
Primary
NONE
WI
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
NONE
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32956300
—
WI
Enumeration date
05/27/2005
Last updated
02/25/2026
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