Organization
JEFFERSON COUNTY
Active
Other names
Jefferson County Human Services
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN M CAULEY (DIRECTOR)
(920) 674-8111
Entity
Organization
Contact information
Practice address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-3105
(920) 674-6113
Mailing address
1541 ANNEX RD, JEFFERSON, WI 53549-9803
(920) 674-3105
(920) 674-6113
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
1449
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20141600
—
WI
05
—
42138100
—
WI
01
—
4333090001
MEDICARE DMERC
WI
01
—
525700
DEAN HEALTH PLAN
WI
Enumeration date
07/15/2005
Last updated
10/11/2011
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