Organization
LA CROSSE COUTNY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME DUMMER (ACCOUNT CLEARK)
(608) 785-6125
Entity
Organization
Contact information
Practice address
300 4TH ST N, LA CROSSE, WI 54601-3228
(608) 785-6101
Mailing address
300 4TH ST N, LA CROSSE, WI 54601-3228
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32977471
—
WI
Enumeration date
07/03/2008
Last updated
07/03/2008
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