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Contact Information

CHILDREN'S MEDICAL GROUP
1215 GEORGE TOWNE DR
PEWAUKEE, WI53072-2731
 Phone: 262-691-3849
 Fax: 262-691-4287
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

208000000X 37 Physician/Pediatric Medicine
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Clinical Child & Adolescent

103TC2200X 62 Psychologist, Clinical
 

Marriage & Family Therapist

106H00000X
 

Mental Health

101YM0800X
 

Professional

101YP2500X
 

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Social Worker

104100000X
Indicates primary specialty

NPI Profile & details for CHILDRENS MEDICAL GROUP · (Female)

NPI Number 1457662074
Status Active
Credentials
Entity Individual
Enumeration date 06/29/2010
Last updated 09/27/2021 - About 5 years ago
Sole proprietor 1 Not specified
Identifiers
  • WI License # 5826-800
  • WI Medicaid 1457662074
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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