Organization
NORTHLAND COMMUNITY SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON S MATTHEW PH.D (DIRECTOR)
(608) 296-2139
Entity
Organization
Contact information
Practice address
161 SPRING ST, WESTFIELD, WI 53964-9068
(608) 296-2139
(608) 296-1590
Mailing address
161 SPRING ST, PO BOX 248, WESTFIELD, WI 53964-9068
(608) 296-2139
(608) 296-1590
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
822
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42119500
—
WI
Enumeration date
05/19/2006
Last updated
08/22/2020
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