Mental Health and Substance Abuse Programs in alphabetical

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DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 226 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 2291 NORTHWEST JOURNEY - WISCONSIN RAPIDS LAURA DUCKETT 110 - 24TH STREET SOUTH WISCONSIN RAPIDS, WI 54494 County: Wood No Email Address Provided Phone: (715) 424-5040 Fax: (715) 424-5720 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 02/12/2001 04/01/2011 03/31/2013 Mental Health-Day Treat/Children 1 w/Telehealth DHS 40.11(2)(a) Mental Health-Day Treatment for Children 1 DHS 40.11(2)(a) 1706 NORTHWEST REGIONAL CENTER BEHAVIORAL HEALTH CLINIC (DIV OF CUMBERLAND MEM) BRUCE JUNGERBERG 1150 - 6TH AVENUE CUMBERLAND, WI 54829 County: Barron bjungerberg@cmhecu.com Phone: (715) 822-6169 Fax: (715) 822-6248 Surveyor: Bradley Jahr Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 12/01/1993 12/01/2011 11/30/2013 Mental Health Outpatient Clinic DHS 35 1707 NORTHWEST REGIONAL CENTER BRENDA RUGGLES-PETERSON 1110 - 7TH AVENUE CUMBERLAND, WI 54829 County: Barron bruggles-peterson@cmhecu.com Phone: (715) 822-6135 Fax: (715) 822-6220 Surveyor: Bradley Jahr Services NO BRANCH LOCATIONS 06/16/2011 03/31/2013 04/01/2011 03/31/2013 Administrative Code Chapter Service Begin/End Dates 04/01/1977 08/01/2012 07/31/2014 Mental Health-Inpatient DHS 61.71 NO BRANCH LOCATIONS 12/01/2011 11/30/2013 Administrative Code Chapter Service Begin/End Dates 08/01/2012 07/31/2014
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 227 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1709 NORWOOD HEALTH CENTER KEN WAHLSTRAND 1600 N. CHESTNUT AVENUE MARSHFIELD, WI 54449 County: Wood No Email Address Provided Phone: (715) 384-2188 Fax: (715) 389-2266 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 04/01/1980 02/01/2011 01/31/2013 CSAS-Medically Monitored Residential Detox DHS 75.07 Mental Health-Inpatient DHS 61.71 1710 NOVA COUNSELING SERVICES, INC HUGH HOLLY 3240 JACKSON STREET OSHKOSH, WI 54901 County: Winnebago hugh@novaoshkosh.com Phone: (920) 231-0143 Fax: (920) 231-4246 Surveyor: Frank Bellaire Services STATE OF WISCONSIN Bureau of Health Services PO Box 2969 Madison, WI 53701-2969 Tier/ Branch Begin/ Branch Location(s) End Dates NO BRANCH LOCATIONS Administrative Code Chapter Service Begin/End Dates 11/01/1985 05/01/2012 04/30/2014 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Outpatient Treatment DHS 75.13 CSAS-Transitional Residential DHS 75.14 2028 OAKWOOD CLINICAL ASSOCIATES, LTD. AMY ANDERSON 4109 - 67TH STREET KENOSHA, WI 53142 County: Kenosha info@oakwoodclinical.com Phone: (414) 652-9830 Fax: (262) 652-2931 Surveyor: Mark Isaacs Services NO BRANCH LOCATIONS 02/01/2011 01/31/2013 02/01/2011 01/31/2013 Administrative Code Chapter Service Begin/End Dates 02/25/1991 03/01/2012 02/28/2014 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 05/01/2012 04/30/2014 05/01/2012 04/30/2014 05/01/2012 04/30/2014 OAKWOOD CLINICAL ASSOCIATES LTD Tier 2 24730 - 75TH ST 03/01/2012 PADDOCK LAKE, WI 53168 02/28/2014 Administrative Code Chapter Service Begin/End Dates 03/01/2012 02/28/2014 03/01/2012 02/28/2014
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Mental Health and Substance Abuse Programs in alphabetical

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