Organization
NORTHSHORE CLINIC OF SHEBOYGAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUE A BALOG LCSW (OWNER PRESIDENT)
(920) 457-8866
Entity
Organization
Contact information
Practice address
615 S 8TH ST, STE G20, SHEBOYGAN, WI 53081-4405
(920) 457-8866
(920) 457-8867
Mailing address
615 S 8TH ST, STE G20, SHEBOYGAN, WI 53081-4405
(920) 457-8866
(920) 457-8867
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42233600
—
WI
Enumeration date
11/14/2005
Last updated
11/16/2011
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