Organization
RAVENSWOOD CLINIC INC
Active
Other names
Ravenswood Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY FRANCIS WERTH JR. MS (EXECUTIVE DIRECTOR)
(414) 224-0492
Entity
Organization
Contact information
Practice address
2266 N PROSPECT AVE, SUITE 608, MILWAUKEE, WI 53202-6306
(414) 224-0492
(414) 224-8112
Mailing address
2266 N PROSPECT AVE, SUITE 326, MILWAUKEE, WI 53202-6306
(414) 224-0492
(414) 224-8112
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2118
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
L12215600
—
WI
Enumeration date
10/19/2006
Last updated
03/27/2014
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