Organization
WAUKESHA COUNTY
Active
Other names
Waukesha County
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) 548-8430
(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
44003200
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44003200
—
WI
Enumeration date
04/19/2007
Last updated
11/10/2025
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