Willow Tree Support Services LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

WILLOW TREE SUPPORT SERVICES LLC

Practice address

2905 W 9TH Ave
Oshkosh, WI 54904-6504

Phone

(920) 379-4388

NPI assigned

Sep 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacob Tetzlaff

Title

Owner

Phone

(920) 379-4388

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347840000000",
    "number": "1245580265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2905 W 9TH AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549046504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2905 W 9TH AVE",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549046504",
            "telephone_number": "920-379-4388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW TREE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-17",
        "last_updated": "2012-09-17",
        "status": "A",
        "authorized_official_last_name": "TETZLAFF",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-379-4388"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea L Williams, RN
• Debra A Williams, RN
• James Mashaun Williams, CSAC, LPC-IT, CSIT
• Stacey Lynn Williams, OTA
• Jane A Williquette, CADCIII,CCSII
• Kandace D Wilson, RN, BSN
• Madison D Wilson, APSW, SAC-IT
• Marjorie Ann Wilson
• Kirsten L Winger
• Winnebag Mental Health Institute

• In Home Supportive Care Agency in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• In Home Supportive Care Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.