Provider Demographics
NPI:1447319116
Name:JEFFERSON COUNTY HEALTH DEPARMENT
Entity type:Organization
Organization Name:JEFFERSON COUNTY HEALTH DEPARMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/HEALTH OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CBE-MC
Authorized Official - Phone:920-674-7186
Mailing Address - Street 1:1541 ANNEX RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9803
Mailing Address - Country:US
Mailing Address - Phone:920-674-7275
Mailing Address - Fax:920-674-7477
Practice Address - Street 1:1541 ANNEX RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9803
Practice Address - Country:US
Practice Address - Phone:920-674-7275
Practice Address - Fax:920-674-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44001400Medicaid
WI41852900Medicaid