Organization
CESA 10
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL HAYNES (ADMINISTRATOR)
(715) 720-2058
Entity
Organization
Contact information
Practice address
725 W PARK AVE, CHIPPEWA FALLS, WI 54729-3276
(715) 720-2058
(715) 720-2070
Mailing address
725 WEST PARK AVENUE, CHIPPEWA FALLS, WI 54729
(715) 720-2058
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Enumeration date
08/04/2015
Last updated
08/04/2015
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