Organization
WAUKESHA COUNTY
Active
Other names
Waukesha County (CSP)
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID M DEROSIER (CREDENTIALING SPECIALIST)
(262) 896-8431
Entity
Organization
Contact information
Practice address
1501 AIRPORT RD, WAUKESHA, WI 53188-3632
(262) 548-7950
(262) 970-4791
Mailing address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-7399
(262) 970-6696
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
43422400
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
43422400
MA PROVIDER NUMBER
WI
05
—
43422400
—
WI
Enumeration date
03/12/2007
Last updated
11/10/2025
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