Provider Demographics
NPI:1043649924
Name:HARRIGAN DEVELOPMENT SERVICES
Entity type:Organization
Organization Name:HARRIGAN DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:HARRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-853-5569
Mailing Address - Street 1:1001 W GLEN OAKS LN
Mailing Address - Street 2:SUITE 245
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3365
Mailing Address - Country:US
Mailing Address - Phone:262-347-3711
Mailing Address - Fax:262-364-2527
Practice Address - Street 1:1001 WEST GLEN OAKS LANE
Practice Address - Street 2:SUITE 245
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-9999
Practice Address - Country:US
Practice Address - Phone:262-347-3711
Practice Address - Fax:262-364-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9999999999OtherCURRENTLY APPLYING FOR MEDICAID