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 282 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1568 ST. JOSEPH'S HOSPITAL ALCOHOL AND DRUG RECOVERY SERVICES SHEILA WEIX 611 ST. JOSEPH'S AVENUE MARSHFIELD, WI 54449 County: Wood Sheila.weix@ministryhealth.org Phone: (715) 387-9700 Fax: (715) 387-9519 Surveyor: Bradley Jahr Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 12/02/1994 12/01/2010 11/30/2012 CSAS-Day Treatment DHS 75.12 CSAS-Medically Managed Inpatient Detox DHS 75.06 CSAS-Medically Managed Inpatient Treatment DHS 75.10 CSAS-Medically Monitored Treatment DHS 75.11 CSAS-Outpatient Treatment DHS 75.13 1865 ST. LUKE'S HOSPITAL KATHLEEN FOREMAN 915 E. FIRST STREET DULUTH, MN 55805 County/State: Saint Louis, MN No Email Address Provided Phone: (218) 249-5555 Fax: (218) 249-2457 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 02/01/1995 02/01/2011 01/31/2013 Mental Health-Inpatient DHS 61.71 2690 ST. LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC KATHLEEN CONNELLY 2900 W OKLAHOMA AVENUE MILWAUKEE, WI 53215 County: Milwaukee No Email Address Provided Phone: (414) 489-4094 Fax: (414) 454-6450 Surveyor: Demetrius Anderson Services NO BRANCH LOCATIONS 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012 12/01/2010 11/30/2012 Administrative Code Chapter Service Begin/End Dates 08/30/2006 09/01/2011 08/31/2013 Mental Health Outpatient Clinic DHS 35 CSAS-Outpatient Treatment DHS 75.13 NO BRANCH LOCATIONS 02/01/2011 01/31/2013 Administrative Code Chapter Service Begin/End Dates 09/01/2011 08/31/2013 09/01/2011 08/31/2012
DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Print Date: 08/28/2012 Page 283 of 335 Certification Number/ Certified Provider's Main Site/ Email/Telephone 1872 ST. MARYS HOSPITAL MEDICAL CENTER LAUREN PALLIN 700 S. PARK STREET MADISON, WI 53715 County: Dane Lauren_E_Pallin@ssmhc.com Phone: (608) 258-6697 Fax: (608) 259-5317 Surveyor: William Rohner Services Community Substance Abuse and Mental Health Program Certification Directory By Provider Name & Certification Number Initial Certification/ Certification Effective/ Certification Expires 06/01/1983 06/01/2010 05/31/2012 Mental Health-Inpatient DHS 61.71 2515 ST. MARY'S HOSPITAL MINISTRY BEHAVIORAL HEALTH INPATIENT ANDREA STEFONEK 2251 N. SHORE DRIVE, #100 RHINELANDER, WI 54501 County: Oneida andrea.stefoneck@ministryheatlh.org Phone: (715) 361-2020 Fax: (715) 361-2021 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 05/01/2004 05/01/2012 04/30/2014 Mental Health-Adolescent Inpatient DHS 61.79 Mental Health-Inpatient DHS 61.71 NO BRANCH LOCATIONS 06/01/2010 05/31/2012 Administrative Code Chapter Service Begin/End Dates 05/01/2012 04/30/2014 05/01/2012 04/30/2014
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Mental Health and Substance Abuse Programs in alphabetical

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