Organization
CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RON PUPP PHD (DIRECTOR OF COUNSELING)
(414) 231-4808
Entity
Organization
Contact information
Practice address
1716 FORDEM AVE, MADISON, WI 53704-4604
(608) 221-3511
(608) 221-3514
Mailing address
1716 FORDEM AVE, MADISON, WI 53704-4604
(608) 221-3511
(608) 221-3514
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42115300
—
WI
Enumeration date
04/14/2008
Last updated
11/23/2011
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