Organization
WAUKESHA COUNTY
Active
Other names
Waukesha County (Fiscal)
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M DEROSIER (CREDENTIALING SPECIALIST)
(262) 896-8431
Entity
Organization
Contact information
Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3632
(262) 548-7399
(262) 970-6696
Mailing address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-7399
(262) 970-6696
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
4307700
WI
251K00000X
Public Health or Welfare Agency
80259
WI
251S00000X
Community/Behavioral Health Agency
32976100
WI
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
42138400
WI
273R00000X
Psychiatric Hospital Unit
10063300
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10063300
—
WI
05
—
10063326
—
WI
05
—
32816300
—
WI
05
—
32976100
—
WI
05
—
41760800
—
WI
05
—
41760800
—
WV
05
—
41861400
—
WI
05
—
42138400
—
WI
05
—
43077000
—
WI
05
—
43422400
—
WI
Enumeration date
04/11/2007
Last updated
11/10/2025
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