Menominee Indian Tribe of Wisconsin

NPI #1124291802 in Keshena, Wisconsin

Provider Information

NPI Number: 1124291802
Entity Type: Organization
Organization Name: Menominee Indian Tribe of Wisconsin
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Apr 2, 2008
Last Updated: Apr 2, 2008

Practice Location

Address: W3275 WOLF RIVER ROAD
City: Keshena
State: Wisconsin
ZIP Code: 54135
Phone: (715) 799-3361

Authorized Official

Name: JERRY L WAUKAU
Title: HEALTH ADMINISTRATOR
Phone: (715) 799-3361

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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