Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
Mental Health and Substance Abuse Programs in alphabetical
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DEPARTMENT OF HEALTH SERVICES<br />
Division of Quality Assurance<br />
Pr<strong>in</strong>t Date: 08/28/2012<br />
Page 108 of 335<br />
Certification Number/<br />
Certified Provider's Ma<strong>in</strong> Site/<br />
Email/Telephone<br />
2838<br />
FOX VALLEY CHILDREN'S MENTAL HEALTH<br />
CENTER<br />
GREG VANDENBERG<br />
1820 APPLETON AVENUE<br />
MENASHA, WI 54952<br />
County: W<strong>in</strong>nebago<br />
gv<strong>and</strong>enberg@chw.org<br />
Phone: (920) 996-2200<br />
Fax: (920) 996-2214<br />
Surveyor: Frank Bellaire<br />
Services<br />
Community <strong>Substance</strong> <strong>Abuse</strong> <strong>and</strong> <strong>Mental</strong> <strong>Health</strong><br />
Program Certification Directory<br />
By Provider Name & Certification Number<br />
Initial Certification/<br />
Certification Effective/<br />
Certification Expires<br />
10/24/2008<br />
11/01/2011<br />
10/31/2013<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic with Telehealth DHS 35<br />
2263<br />
FOX VALLEY PSYCHIATRIC ASSOCIATES<br />
MICHAEL PANZER, MD<br />
3301-C NORTH BALLARD ROAD<br />
APPLETON, WI 54911<br />
County: Outagamie<br />
fvpa1@yahoo.com<br />
Phone: (920) 202-3954<br />
Fax: (920) 202-3964<br />
Surveyor: Frank Bellaire<br />
Services<br />
STATE OF WISCONSIN<br />
Bureau of <strong>Health</strong> Services<br />
PO Box 2969<br />
Madison, WI 53701-2969<br />
Tier/<br />
Branch Beg<strong>in</strong>/<br />
Branch Location(s) End Dates<br />
CHILD ADVOCACY CENTER Tier 1<br />
325 NORTH COMMERCIAL STREET<br />
11/01/2011<br />
NEENAH, WI 54956<br />
10/31/2013<br />
FOX VALLEY CHILDREN'S MENTAL<br />
HEALTH CTR<br />
Tier 1<br />
545 S JOHN STREET<br />
11/01/2011<br />
KIMBERLY, WI 54136<br />
10/31/2013<br />
FOX VALLEY CHILDREN'S MENTAL<br />
HEALTH CTR<br />
Tier 1<br />
2725 E FOREST STREET<br />
11/01/2011<br />
APPLETON, WI 54915<br />
10/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/26/2000<br />
10/01/2010<br />
09/30/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Outpatient Treatment DHS 75.13<br />
2076<br />
FROEDTERT HEALTH COMMUNITY MEMORIAL<br />
HOSPITAL<br />
LYNN DUNN<br />
W180 N8085 TOWN HALL ROAD<br />
MENOMONEE FALLS, WI 53051<br />
County: Waukesha<br />
ldunn@froedterthealth.org<br />
Phone: (262) 257-3580<br />
Fax: (262) 257-2570<br />
Surveyor: Mark Isaacs<br />
Services<br />
NO BRANCH LOCATIONS<br />
11/01/2011 10/31/2013<br />
11/01/2011 10/31/2013<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
10/01/1982<br />
09/01/2010<br />
08/31/2012<br />
<strong>Mental</strong> <strong>Health</strong> Outpatient Cl<strong>in</strong>ic DHS 35<br />
CSAS-Medically Managed Inpatient Detox DHS 75.06<br />
CSAS-Outpatient Treatment DHS 75.13<br />
<strong>Mental</strong> <strong>Health</strong>-Inpatient DHS 61.71<br />
NO BRANCH LOCATIONS<br />
10/01/2010 09/30/2012<br />
10/01/2010 09/30/2012<br />
Adm<strong>in</strong>istrative<br />
Code Chapter Service Beg<strong>in</strong>/End Dates<br />
09/01/2010 08/31/2012<br />
09/01/2010 08/31/2012<br />
09/01/2010 08/31/2012<br />
09/01/2010 08/31/2012
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