Basic Information
| Provider Information | |||||||||
| NPI: | 1790808269 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNIVERSITY HEALTH AND COUNSELING SERVICES | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | UNIVERSITY OF WISCONSIN - WHITEWATER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 800 W MAIN ST | ||||||||
| Address2: | UW-WHITEWATER | ||||||||
| City: | WHITEWATER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531901705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624721300 | ||||||||
| FaxNumber: | 2624725608 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W MAIN ST | ||||||||
| Address2: | UW-WHITEWATER | ||||||||
| City: | WHITEWATER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531901705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2624721300 | ||||||||
| FaxNumber: | 2624725608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SWISHER | ||||||||
| AuthorizedOfficialFirstName: | RUTH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2624721300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | R.N. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | 85167030 | WI | N | Ambulatory Health Care Facilities | Clinic/Center | Student Health | 261QS1000X | 2561033 | WI | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
ID Information
| ID | Type | State | Issuer | Description | 2561033 | 01 | WI | APNP | OTHER | 85167030 | 01 | WI | R.N. | OTHER | MB1198073 | 01 | WI | DEA | OTHER |