Organization
COMMUNITY SERVICE ASSOCIATES, SC
Active
Other names
d/b/a Pauquette Center, Pauquette Center for Psychological Services
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY D STEVENS (CREDENTIALING DEPT/BUSINESS MANAGER)
(608) 742-5518
Entity
Organization
Contact information
Practice address
2901 HUNTERS TRL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Mailing address
PO BOX 301, 2901 HUNTERS TRAIL, PORTAGE, WI 53901-3403
(608) 742-5518
(608) 742-4087
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
2149
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
292394
VALUE OPTIONS
WI
01
—
501113
DEAN HEALTH PLAN
WI
01
—
CD8222
RAILROAD MEDICARE
WI
01
—
W010102
TRICARE/CHAMPUS
WI
Enumeration date
06/22/2006
Last updated
07/25/2024
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