State of Wisconsin

NPI #1386705655 in Madison, Wisconsin

Provider Information

NPI Number: 1386705655
Entity Type: Organization
Organization Name: State of Wisconsin
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Dec 12, 2006
Last Updated: Dec 10, 2024

Practice Location

Address: 317 KNUTSON DR
City: Madison
State: Wisconsin
ZIP Code: 53704-1133
Phone: (608) 301-9200

Authorized Official

Name: DR. WALTON O SCHALICK III, MD,PHD
Title: MEDICAL DIRECTOR
Phone: (609) 301-9231

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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