Organization
WILLOWGLEN ACADEMY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LEONARD F DZIUBLA LCSW (PRESIDENT & CEO)
(414) 225-4460
Entity
Organization
Contact information
Practice address
3903 W LISBON AVE, MILWAUKEE, WI 53208-1835
(414) 342-2060
(414) 342-3663
Mailing address
1744 N FARWELL AVE, MILWAUKEE, WI 53202-1806
(414) 225-4460
(414) 225-4469
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
2366
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2366
STATE LICENSE
WI
05
—
43003300
—
WI
Enumeration date
01/16/2007
Last updated
08/22/2020
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