Autism Society of Greater Wisconsin

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

Legal business name

AUTISM SOCIETY OF GREATER WISCONSIN

Practice address

1477 Kenwood Dr Ste 100
Menasha, WI 54952-1160

Phone

(920) 558-4602

Fax

(920) 558-4611

NPI assigned

Jun 3, 2019

Last updated

Jun 3, 2019By 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

Kelly Brodhagen

Title

Office Manager

Phone

(920) 558-4602

Specialties & licenses 1

Addresses

Other names 1

• Autism Society of Wisconsin Former legal business name

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559520000000",
    "number": "1629636873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 KENWOOD DR STE 100",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521160",
            "telephone_number": "920-558-4602",
            "fax_number": "920-558-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1477 KENWOOD DR STE 100",
            "city": "MENASHA",
            "state": "WI",
            "postal_code": "549521160",
            "telephone_number": "920-558-4602",
            "fax_number": "920-558-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTISM SOCIETY OF GREATER WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "status": "A",
        "authorized_official_last_name": "BRODHAGEN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "920-558-4602"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbrodhagen@autismgreaterwi.org",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1477 Kenwood Dr Ste 100",
            "city": "Menasha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549521160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Autism Society of Wisconsin",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Voluntary or Charitable Agency in Menasha, WI
• Providers in Menasha, WI by specialty
• Voluntary or Charitable Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.