Provider Demographics
NPI:1871508515
Name:COUNTY OF DODGE
Entity type:Organization
Organization Name:COUNTY OF DODGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-386-3534
Mailing Address - Street 1:199 COUNTY ROAD DF
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:JUNEAU
Mailing Address - State:WI
Mailing Address - Zip Code:53039-9512
Mailing Address - Country:US
Mailing Address - Phone:920-386-3500
Mailing Address - Fax:920-386-4564
Practice Address - Street 1:199 COUNTY ROAD DF
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JUNEAU
Practice Address - State:WI
Practice Address - Zip Code:53039-9512
Practice Address - Country:US
Practice Address - Phone:920-386-3500
Practice Address - Fax:920-386-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1282251S00000X
261Q00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42139700Medicaid
WI42139700Medicaid