Basic Information
| Provider Information | |||||||||
| NPI: | 1164664603 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EASTER SEALS SOUTHEAST WISCONSIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 S. 114TH STREET | ||||||||
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| City: | WEST ALLIS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144494444 | ||||||||
| FaxNumber: | 4145715568 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 NORTHVIEW ROAD | ||||||||
| Address2: | |||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625476821 | ||||||||
| FaxNumber: | 2625476883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2009 | ||||||||
| LastUpdateDate: | 03/20/2017 | ||||||||
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| AuthorizedOfficialLastName: | SCHAEFER | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4149635902 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251C00000X | 1827800 | WI | Y | Agencies | Day Training, Developmentally Disabled Services |
No ID Information.