Organization
LAKESHORES OUTPATIENT CLINIC
Active
Other names
Brotoloc
Organization subpart
No
Provider details
NPI number
Authorized official
MELANIE BARBEAUX-STINSON BA (DIRECTOR)
(262) 656-9975
Entity
Organization
Contact information
Practice address
3917 47TH AVE, KENOSHA, WI 53144-1956
(262) 656-9975
(262) 656-9974
Mailing address
3917 47TH AVE, KENOSHA, WI 53144-1956
(262) 656-9975
(262) 656-9974
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2605
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42242400
—
WI
Enumeration date
02/15/2007
Last updated
08/22/2020
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