Provider Demographics
NPI:1043634595
Name:BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES
Entity type:Organization
Organization Name:BAYFIELD COUNTY DEPARTMENT OF HUMAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SKULAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-373-6144
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:117 EAST FIFTH STREET
Mailing Address - City:WASHBURN
Mailing Address - State:WI
Mailing Address - Zip Code:54891-0100
Mailing Address - Country:US
Mailing Address - Phone:715-373-6144
Mailing Address - Fax:715-373-6130
Practice Address - Street 1:117 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WASHBURN
Practice Address - State:WI
Practice Address - Zip Code:54891-4522
Practice Address - Country:US
Practice Address - Phone:715-373-6144
Practice Address - Fax:715-373-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801085451Medicaid