1326123175 NPI number — MR. WILLIAM STEPHEN M.S., CADC III

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326123175 NPI number — MR. WILLIAM STEPHEN M.S., CADC III

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHEN
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CADC III
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326123175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16535 W BLUEMOUND RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-5936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-789-1191
Provider Business Mailing Address Fax Number:
262-821-6180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4811 S 76TH ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53220-4364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-817-9331
Provider Business Practice Location Address Fax Number:
414-817-0442
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 397-857-00 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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