Organization
CHILDREN'S SERVICE SOCIETY OF WISCONSIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY OERTER (INTERIM DIRECTOR OF COUNSELING)
(414) 266-2912
Entity
Organization
Contact information
Practice address
8207 22ND AVE, SUITE 155, KENOSHA, WI 53143-6211
(262) 652-5522
(262) 652-7228
Mailing address
8207 22ND AVE, SUITE 155, KENOSHA, WI 53143-6211
(262) 652-5522
(262) 652-7228
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42210200
—
WI
Enumeration date
04/14/2008
Last updated
12/05/2013
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