Willow Creek Ranch, Inc.

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

091707 Issued in WI

Legal business name

WILLOW CREEK RANCH, INC.

Practice address

7404 Northwest Hwy # 83
Mukwonago, WI 53149-8903

Phone

(414) 791-2509

NPI assigned

May 4, 2015

Last updated

May 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jennifer S. Pape, REGISTERED INSTRUCTO

Title

Founder/Executive Director

Phone

(414) 791-2509

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1430697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1417334988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7404 NORTHWEST HWY # 83",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531498903",
            "telephone_number": "414-791-2509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 NORTHWEST HWY # 83",
            "city": "MUKWONAGO",
            "state": "WI",
            "postal_code": "531498903",
            "telephone_number": "414-791-2509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK RANCH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-04",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "PAPE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "FOUNDER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "414-791-2509",
        "authorized_official_credential": "REGISTERED INSTRUCTO"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "WI",
            "license": "091707",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091707",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Kristin Carol Welch, MSN, APNP, FNP-C
• Susan Leone Whanger, RN
• Kelly Kay Winkelman, OTR
• Wisconsin Dental Group, S.C. (ForwardDental Mukwonago)
• Alison Wittchow
• Thomas James Wojciechowski Jr.
• Wolf Family Chiropractic, LLC

• Adolescent and Children Mental Health Clinic/Center in Mukwonago, WI
• Providers in Mukwonago, WI by specialty
• Adolescent and Children Mental Health Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; 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.