Intoxicated Driver Program Directory. To: State, County, and Local Officials Involved with the Intoxicated Driver Program
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1 To: State, County, and Local Officials Involved with the Intoxicated Driver Program This directory has been updated in response to requests from county staff working with the Intoxicated Driver Program (IDP). Intoxicated drivers, boaters, snowmobile users, all-terrain vehicle users, and possessors of certain controlled substances (cocaine, heroin, lysergic acid diethylamide, phencyclidine, amphetamine, methamphetamine, psilocin, or psilocybin), may be referred to the correct IDP contact within a Wisconsin county with the use of this directory. Contact the Designated Coordinator regarding information about each county s programs and policies for assessment and/or treatment services. Contact the assessment facility contact regarding court ordered referrals and reports. Collateral information regarding the referral should be sent to the assessment facility contact. When speaking with an individual needing an assessment, please inform them that they should contact the assessment facility for an appointment FIRST BY PHONE. A non-resident should contact the facility the day of their court appearance. Most assessments take 1-2 hours. Previously this directory was available as a printed document but due to the advantages of the internet the directory will be web-based. This will facilitate fluid updates as the information changes. This directory is available for viewing and printing at: Please submit updated staff, contact, and fee information for this directory to the IDP Coordinator whose contact information is listed on the following page. We welcome your comments and suggestions for improvements to this directory. Substance Abuse Services Section STATE OF WISCONSIN DEPARTMENT OF HEALTH SERVICES Division of Mental Health and Substance Abuse Services Bureau of Prevention Treatment and Recovery P (09/2015) 1
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3 GENERAL INFORMATION Website: index.htm Intoxicated Driver Program LeeAnn Cooper, IDP Coordinator Department of Health Services Division of Mental Health and Substance Abuse Services Bureau of Prevention Treatment and Recovery 1 West Wilson Street, Room 850 PO Box 7851 Madison WI Telephone: (608) Fax: (608) leeann.cooper@wisconsin.gov Intoxicated Driver Assessor Training: Kristi Obmascher University of Wisconsin-Madison Department of Professional Development and Applied Studies 313 Lowell Center 610 Langdon Street Madison WI Telephone: (608) kobmascher@dcs.wisc.edu Submit updated staff, contact, and fee information for this directory to: LeeAnn Cooper Bureau of Prevention Treatment and Recovery 1 West Wilson Street, Room 850 Madison WI Telephone: (608) Fax: (608) leeann.cooper@wisconsin.gov 3
4 FORMS WISCONSIN DEPARTMENT OF TRANSPORTATION MOTOR VEHICLE (MV) FORMS FORM N0. FORM TITLE PACKAGE SIZE MV 3631 Driver Safety Plan Final Report 100 per package MV 3632 Court Order for Intoxicated Driver Assessment & Driver Safety Plan 100 per package MV 3633 Driver Safety Plan Order 100 per package MV 3634 Order for Assessment & Driver Safety Plan Report 100 per package Motor Vehicle (MV) form orders require the form number, form title, quantity needed and your ship to address in writing: By Mail: Maps and Publication Sales Wisconsin Department of Transportation 3617 Peirstorff Street P.O. Box 7713 Madison, WI By Fax: (608)
5 WISCONSIN DEPARTMENT OF HEALTH SERVICES FORMS FOR INTOXICATED USE OF MOTORIZED RECREATIONAL VEHICLES Forms for intoxicated use of motorized recreational vehicles, Including Boats, Snowmobiles, All-Terrain Vehicles, and Possession of Certain Controlled Substances are produced by the Wisconsin Department of Health Services (DHS) and are available from: for printing and down-load. FORM NUMBER FORM TITLE LANGUAGE F Wisconsin Assessment of the Impaired Driver (WAID) 50 per package Only designated assessment facilities may order copies of the WAID: Complete a F-82025A and the completed form as an attachment to DHSFMDDEPDE@wisconsin.gov. F Court Order for Assessment English F-20933S Orden de la Corte Para Evaluacion Spanish F Court Ordered Assessment and Plan Report English F-20934A Plan Recommendation English F-20934S Evaluacion Ordenada Por la Corte Y Reporte Del Plan Spanish F-20934AS Plan de Recommendacion Spanish F Status Report to Court for Plan Compliance English 5
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7 Intoxicated Driver Program Contact information by County ADAMS COUNTY Kay Saarinen-Barr Adams County Health and Human Services Department 108 East North Street Friendship WI Telephone: (608) Fax: (608) Kay Saarinen-Barr Adams County Health and Human Services Department 108 East North Street Friendship WI Telephone: (608) Fax: (608) $ Assessment Fee $50.00 Reinstatement Fee 7
8 ASHLAND COUNTY Linda Bailey, Adult Services Supervisor Ashland County Health and Human Services Department 630 Sanborn Avenue Ashland WI Telephone: (715) Ext. 138 Fax: (715) Allison Allen, Director of Behavioral Health Services NorthLakes Community Clinic 502 West Main St., Suite 305 Ashland WI Telephone: (715) Fax: (715) $ Assessment Fee $50.00 Rescheduling Fee $25.00 Reinstatement Fee $25.00 Amend Driver Safety Plan / Extend Driver Safety Plan 8
9 Bad River Band of Lake Superior Chippewa Tribe This assessment agency is available only to tribal members and their families Laura Moore Bad River AODA Program Nokomis Road Ashland, WI Telephone: (715) ext Laura Moore Bad River AODA Program Nokomis Road Ashland, WI Telephone: (715) ext $200 Assessment Fee 9
10 BARRON COUNTY Dave Hensley Barron County Department of Health and Human Services 335 E. Monroe Avenue Barron WI Telephone: (715) Fax: (715) Arlene Eslinger Community Counseling Services County Hwy X Chippewa Falls WI Telephone: (715) Fax: (715) arleneeslinger@sbcglobal.net $ Assessment Fee 10
11 BAYFIELD COUNTY Cheryl Hanson, AODA / MH Coordinator Bayfield County Department of Human Services P.O. Box 100 Washburn WI Telephone: (715) x133 Fax: (715) CHanson@bayfieldcounty.org Allison Allen, Director of Behavioral Health Services NorthLakes Community Clinic 502 West Main Street, Suite 305 Ashland WI Telephone: (715) Fax: (715) sesala@northlakesclinic.org $ Assessment Fee $50.00 Rescheduling Fee $25.00 Reinstatement Fee $25.00 Amend Driver Safety Plan / Extend Driver Safety Plan 11
12 BROWN COUNTY Julie Feld, AODA Clinical Supervisor Brown County Community Treatment Center / AODA Dept Gershwin Drive Green Bay WI Telephone: (920) Fax: (920) Feld_JB@co.brown.wi.us Julie Feld, AODA Clinical Supervisor Brown County Community Treatment Center /AODA Dept Gershwin Drive Green Bay WI Telephone: (920) Fax: (920) Feld_JB@co.brown.wi.us $ Assessment Fee $ Failed Appointment $ Reschedule Fee if less than 24 hour notice $ Amend Driver Safety Plan 12
13 BUFFALO COUNTY Jennifer Nelson Buffalo County Department of Health and Human Services Courthouse P.O. Box 517 Alma WI Telephone: (608) Fax: (608) Rob Pitsman Triniteam 202 Graham Avenue Eau Claire WI Telephone: (715) Fax: (715) $ Assessment Fee (paid at any time) $ Assessment Fee if paid within first 2 week 13
14 BURNETT COUNTY Byron Hopke Burnett County Department Health and Human Services 7410 County Road K, Suite 280 Siren WI Telephone: (715) Fax: (715) Ana Winton Aurora Community Counseling (ACC), Inc State Road 35/70, Unit D Siren WI Telephone: (715) Fax: (715) awinton@auroraservices.com $ Assessment Fee $ Fail Appointment $ Extension of Driver Safety Plan $ Reinstatement of Drivers Safety Plan from non-compliance to compliance 14
15 CALUMET COUNTY Kristi LeClair Calumet County Department of Human Services Courthouse, 206 Court Street Chilton WI Telephone: (920) Fax: (920) Kelly Schoen Calumet County Department of Human Services Courthouse, 206 Court Street Chilton WI Telephone: (920) ext. 387 Fax: (920) $ Assessment Fee $ Failed Appointment $25.00 Payment Plan Set-up $50.00 DSP Amendment 15
16 CHIPPEWA COUNTY Tim Easker Chippewa County Department of Human Services 711 North Bridge Street, Room 122 Chippewa Falls WI Telephone: (715) Fax: (715) Arlene Eslinger Community Counseling Services County Hwy X Chippewa Falls WI Telephone: (715) Fax: (715) arleneeslinger@sbcglobal.net $ Assessment Fee 16
17 CLARK COUNTY Russell Girard Clark County Community Services 517 Court Street, Room 503 Neillsville WI Telephone: (715) Fax: (715) Jeanine Voigt Clark County Community Services 517 Court Street, Room 503 Neillsville WI Telephone: (715) Fax: (715) $ Assessment Fee $70.00 Non-Compliance Fee $ No-show/Reschedule fee $70.00 Amendment/Extension fee 17
18 COLUMBIA COUNTY Dr. Thomas Hayes Pauquette Center 2901 Hunters Trail P.O. Box 301 Portage WI Telephone: (608) Fax: (608) Sheila Starr Pauquette Center 2901 Hunters Trail P.O. Box 301 Portage WI Telephone: (608) Fax: (608) $ Assessment Fee 18
19 CRAWFORD COUNTY Dan McWilliams, Director Crawford County Human Services Department 225 North Beaumont Road, Suite 326 Prairie du Chien WI Telephone: (608) Fax: (608) David Nelson Franciscan Skemp Behavioral Health (Villa Succés) 121 South Prairie Street Prairie du Chien WI Telephone: (608) Fax: (608) $ OWI Assessment $ Underage assessment and education 19
20 DANE COUNTY Todd Campbell Alcohol and Other Drug Abuse Manager Dane County Department of Human Services 1202 Northport Drive Madison, Wisconsin Office: (608) Fax: (608) Margie Duncan Journey Mental Health Center Clinical Assessment Unit 710 John Nolen Drive Madison WI Telephone: (608) Fax: (608) $ Assessment Fee $50.00 Extension of Driver Safety Plan $75.00 Reinstatement Fee $50.00 Failed Appointment 20
21 DODGE COUNTY Sara Gaska Dodge County Human Services and Health Department 199 County Road DF Juneau WI Telephone: (920) Fax: (920) Sandra Eichmann Dodge County Human Services and Health Department 199 County Road DF Juneau WI Telephone: (920) Fax: (920) $ Assessment Fee 21
22 DOOR COUNTY Joe Krebsbach Door County Department of Human Services 421 Nebraska Street Sturgeon Bay WI Telephone: (920) Fax: (920) Peggy Kubiak Door County Department of Human Services 421 Nebraska Street Sturgeon Bay WI Telephone: (920) Fax: (920) $ Assessment Fee 22
23 DOUGLAS COUNTY Dave Longsdorf Douglas County Department of Health and Human Services 1316 North 14th Street, Suite 400 Superior WI Telephone: (715) Fax: (715) Dave Longsdorf Douglas County Department of Health and Human Services 1316 North 14th Street, Suite 400 Superior WI Telephone: (715) Fax: (715) $ Assessment Fee $50.00 Failed or rescheduled Appointment fee $50.00 Amend or Extend Driver Safety Plan $50.00 Out-of-State Transfer Fee 23
24 DUNN COUNTY Kris Korpela Dunn County Department of Human Services 808 Main Street P.O. Box 470 Menomonie WI Telephone: (715) Fax: (715) Jill Gamez Arbor Place st Street NE Menomonie WI Telephone: (715) Fax: (715) $ OWI Assessment Fee $ Failed Appointment $ Late Cancellation 24
25 EAU CLAIRE COUNTY Craig Olson Eau Claire County Department of Human Services 721 Oxford Avenue Eau Claire WI Telephone: (715) Fax: (715) Ann Feller Eau Claire Community Program 101 N. Farwell St. Ste 204 Eau Claire WI Telephone: (715) Fax: (715) Online application: $ Assessment Fee (Walk-in) $ Assessment Fee (Online) $65.00 Final Follow-Up Fee $65.00 No Show Fee $65.00 Late Cancellation Fee 25
26 FLORENCE COUNTY Janet Nanninga Florence County Human Services Department CourthouseP.O. Box 225 Florence WI Telephone: (715) Fax: (715) Kristina Williams Florence County Human Services Department Courthouse P.O. Box 225 Florence WI Telephone: (715) Fax: (715) $ Assessment Fee 26
27 FOND DU LAC COUNTY Lynn Klapperich Fond du Lac County Department of Community Programs 459 East First Street Fond du Lac WI Telephone: (920) Fax: (920) Barbara Higgins Fond du Lac County Department of Community Programs 459 East First Street Fond du Lac WI Telephone: (920) Fax: (920) $ Assessment Fee $ Failed Appointment 27
28 FOREST COUNTY Donna M. Shimeck, MA, LCSW The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1256 Fax: (715) ds@thehumanservicecenter.org Jodi Baker, SAC, IDP-AT The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1229 Fax: (715) jb@thehumanservicecenter.org $ Assessment Fee $ Failed Appointment/Late Cancelation $50.00 Amendment 28
29 GRANT COUNTY Diana Kroeber, AODA Supervisor Unified Community Services 200 West Alona Lane Lancaster WI Telephone: (608) Fax: (608) Diana Kroeber, AODA Supervisor Unified Community Services 200 West Alona Lane Lancaster WI Telephone: (608) Fax: (608) $ Assessment Fee $ IDP Failed Appointment $25.00 Other Failed Appointment 29
30 GREEN COUNTY Bob Gibson Green County Human Services N3152 State Hwy 81 Monroe WI Telephone: (608) (AODA Office) Fax: (608) Marlene Bergemann Green County Human Services N3152 State Hwy 81 Monroe WI Telephone: (608) Fax: (608) $ $ IDP Fee $50.00 No show Fee $92.00/hour Additional appointments to change/extend driver safety plan, etc. 30
31 GREEN LAKE COUNTY Jana Tetzlaff, Clinical Services Manager Green Lake County Department of Health and Human Services 571 County Road A P.O. Box 588 Green Lake WI Telephone: (920) Telephone: (800) Fax: (920) jtetzlaff@co.green-lake.wi.us Jana Tetzlaff, Clinical Services Manager Green Lake County Department of Health and Human Services 571 County Road A P.O. Box 588 Green Lake WI Telephone: (920) Telephone: (800) Fax: (920) jtetzlaff@co.green-lake.wi.us $ Assessment Fee $65.00 Amend Driver Safety Plan No Show / Forfeit Fees 31
32 IOWA COUNTY Diana Kroeber, AODA Supervisor Unified Community Services 1122 Professional Drive Dodgeville WI Telephone: (608) Fax: (608) Diana Kroeber, AODA Supervisor Unified Community Services 1122 Professional Drive Dodgeville WI Telephone: (608) Fax: (608) $ Assessment Fee $ IDP Failed Appointment $25.00 Other Failed Appointment 32
33 IRON COUNTY Carolyn Kolson-Janov Iron County Dept. of Human Services Courthouse 300 Taconite St., Suite 201 Hurley WI Telephone: (715) Fax: (715) Sally Langland Iron County Dept. of Human Services Courthouse 300 Taconite St., Suite 201 Hurley WI Telephone: (715) Fax: (715) $ Assessment Fee (Must be paid by cash or money order before an assessment appointment can be scheduled 33
34 JACKSON COUNTY Heather Hainz, Behavioral Health Unit Manager Jackson County Health and Human Services Department 420 Hwy 54 West P.O. Box 457 Black River Falls WI Telephone: (715) Fax: (715) Karla Gearing Jackson County Health and Human Services Department 420 Hwy 54 West P.O. Box 457 Black River Falls WI Telephone: (715) Fax: (715) $ OWI Fee $50.00 Rescheduling fee $50.00 Amendment fee 34
35 JEFFERSON COUNTY Holly Pagel, Outpatient Clinic Supervisor Jefferson County Human Services Department 1541 Annex Road Jefferson WI Telephone: (920) Fax: (920) Jude Christensen Lead IDP Assessor Jefferson County Human Services Department 1541 Annex Road Jefferson WI Telephone: (920) Fax: (920) $ Assessment and Driver Safety Plan Fee $ Missed Appointment Fee $95.00 Amended Paperwork Fee $93.00 Extension of Driver Safety Plan $ Reinstatement of Driver Safety Plan from non-compliance to compliance $ Transfer of paperwork to or from another county $ Out of State packets 35
36 JUNEAU COUNTY Charles Lipford Juneau County Department of Human Services Courthouse Annex 220 East La Crosse Street Mauston WI Telephone: (608) Fax: (608) Charles Lipford Juneau County Department of Human Services Courthouse Annex 220 East La Crosse Street Mauston WI Telephone: (608) Fax: (608) $ Assessment Fee ($50.00 non-refundable deposit at time of scheduling) $50.00 Transfer Fee 36
37 KENOSHA COUNTY Guida Brown Hope Council th Avenue Kenosha WI Telephone: (262) Fax: (262) Cheryl Pataska Hope Council th Avenue Kenosha WI Telephone: (262) Fax: (262) Assessment Charge $ Assessment Fee $ Biomarker Fee for drivers with 3 or more offenses $50.00 No Show/Rescheduling without 24 hour notice (first time) $75.00 No Show/Rescheduling without 24 hour notice (second time) $ No Show/Rescheduling without 24 hour notice (third or more times) $50.00 Non-Compliance Fee after 14 days $25.00 No Show for Victim Impact Panel Additional fees apply for direct biomarker testing 37
38 KEWAUNEE COUNTY Scott R. Gartzke Kewaunee County Department of Human Services 810 Lincoln Street Kewaunee WI Telephone: (920) Fax: (920) Scott R. Gartzke Kewaunee County Department of Human Services 810 Lincoln Street Kewaunee WI Telephone: (920) Fax: (920) $ Assessment Fee $ Amended Driver Safety Plan Fee $75.00 Driver Safety Plan Extension Fee $ Updated Assessment Fee $ Reinstatement Fee $ Missed Appointment Fee $50.00 Paperwork Transfer Fee 38
39 Lac du Flambeau Lake Superior Chippewa Indians This assessment agency is available only to tribal members and their family Lisa Mohawk Family Resource Center 533 Peace Pipe Road Lac du Flambeau WI Telephone: (715) Lisa Mohawk Family Resource Center 533 Peace Pipe Road Lac du Flambeau WI Telephone: (715) $ Assessment Fee $ No Show Fee $ Late/cancellation Fee $50.00 Amended/extended DSP Fee 39
40 LA CROSSE COUNTY Becky Spanjers, Chemical Health Supervisor La Crosse County Human Services Chemical Health and Justice Sanctions 333 Vine Street, Room 740 La Crosse WI Telephone: (608) Fax: (608) Becky Spanjers, Chemical Health Supervisor La Crosse County Human Services Chemical Health and Justice Sanctions 333 Vine Street, Room 740 La Crosse WI Telephone: (608) Fax: (608) Assessment Charge $ Assessment Fee $20.00 Failed Appointment $25.00 Transfer Fee 40
41 LAFAYETTE COUNTY Shane Schuhmacher, Director Lafayette County Human Services Department 627 Main Street Darlington WI Telephone: (608) Fax: (608) Sheena Abbitt Lafayette County Human Services Department 627 Main Street Darlington WI Telephone: (608) Fax: (608) $ OWI Assessment Fee $ IDP Failed Appointment Fee $50.00 Amended/Non-compliance/Extension Fee $25.00 Other Failed Appointment Fee 41
42 LANGLADE COUNTY Tanya Zaloudek North Central Health Care Center 1225 Langlade Road Antigo WI Telephone: (715) Fax: (715) Karen Slattery North Central Health Care Center 1225 Langlade Road Antigo WI Telephone: (715) Fax: (715) $ Assessment Fee $57.00 Failed Appointment 42
43 LINCOLN COUNTY Tanya Zaloudek North Central Health Care Merrill Center 607 North Sales St. Merrill WI Telephone: (715) Fax: (715) Karen Slattery North Central Health Care Merrill Center 607 North Sales St. Merrill WI Telephone: (715) Fax: (715) $ Assessment Fee $57.00 Failed Appointment 43
44 MANITOWOC COUNTY Gary Daehn Manitowoc County Human Services Department 926 South 8th Street P.O. Box 1177 Manitowoc WI Telephone: (920) Fax: (920) Gary Daehn Manitowoc County Human Services Department 926 South 8th Street P.O. Box 1177 Manitowoc WI Telephone: (920) Fax: (920) $ Assessment Fee $ Failed Appointment $40.00 Extension Fee $40.00 Amendment Fee 44
45 MARATHON COUNTY Lynne Buechler North Central Health Care Center 1100 Lakeview Drive Wausau, WI Telephone: Fax: (715) Lynne Buechler North Central Health Care Center 1100 Lake View Drive Wausau WI Telephone: (715) Fax: (715) $ Assessment Fee $57.00 Failed Appointment 45
46 MARINETTE COUNTY Rob Valentine Marinette County Human Services Department 2500 Hall Avenue Marinette WI Telephone: (715) Fax: (715) Rob Valentine Marinette County Human Services Department 2500 Hall Avenue Marinette Wisconsin Telephone: (715) Fax: (715) $ Assessment Fee $ Failed Appointment / Reschedule Fee $ Amendment Fee 46
47 MARQUETTE COUNTY Mandy Stanley Marquette County Human Services 480 Underwood Avenue P.O. Box 405 Montello WI Telephone: (608) Fax: (608) Tiffany Schmit Marquette County Human Services-Clinical Services 480 Underwood Avenue P.O. Box 405 Montello WI Telephone: (608) Fax: (608) $ Assessment Fee $ Failed Appointment $ Out-of-State Packet $65.00 Amend Driver Safety Plan 47
48 MENOMINEE COUNTY Amy Zimmer, Program Manager Menominee County Health and Human Services Department W3272 Wolf River Road P.O. Box 280 Keshena WI Telephone: (715) Fax: (715) Amy Zimmer, Program Manager Menominee County Health and Human Services Department W3272 Wolf River Road P.O. Box 280 Keshena WI Telephone: (715) Fax: (715) $ Assessment Fee State IDP $ Assessment Fee Tribal IDP $220.00/ Failed Appointment $50.00 Driver Safety Plan Amendment Fee $25.00 Cancellation Fee 48
49 MILWAUKEE COUNTY Patricia Gutierrez Impact, Inc West Washington Street, Suite 2225 West Allis WI Telephone: (414) (Appointments) Telephone: (414) (General Information) Fax: (414) Patricia Gutierrez Impact, Inc West Washington Street, Suite 2225 West Allis WI Telephone: Telephone: (Appointments) Fax: $ Wisconsin Resident OWI Fee $ Failed Appointment (Non-Wisconsin residents: call the Appointment Desk for more information) 49
50 MONROE COUNTY Lori Svendsen Monroe County Department of Human Services County Hwy B, A-19 Sparta WI Telephone: (608) Fax: (608) Lori Svendsen Monroe County Department of Human Services County Hwy B, A-19 Sparta WI Telephone: (608) Fax: (608) $ Assessment Fee (Pay at scheduling) $ Failed Appointment $ Redevelopment of Driver Safety Plan 50
51 OCONTO COUNTY Julie Whitworth Oconto County Department of Health and Human Services 501 Park Avenue Oconto WI Telephone: (920) Fax: (920) Barb Rasmussen Oconto County Department of Health and Human Services 501 Park Avenue Oconto WI Telephone: (920) Fax: (920) $ Assessment Fee 51
52 ONEIDA COUNTY Donna M. Shimeck, MA, LCSW The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1256 Fax: (715) ds@thehumanservicecenter.org Jodi Baker, SAC, IDP-AT The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1229 Fax: (715) jb@thehumanservicecenter.org $ Assessment Fee $ Failed Appointment/Late Cancellation $50.00 Amendment 52
53 OUTAGAMIE COUNTY Brian Bezier, Psy.D Outagamie County Health & Human Services 401 South Elm Street Appleton WI Telephone: (920) Fax: (920) Carrie Burton Theda Care Behavioral Health Services 1095 Midway Road Menasha WI Telephone: (920) (Appt Desk) Telephone: (920) (IDP Info) Fax: (920) $ Assessment Fee $ Failed Appointment $ Amend Driver Safety Plan $ Remove Status of Non-Compliance 53
54 OZAUKEE COUNTY Lynn Gillian Ozaukee County Department of Human Services 121 West Main Street Port Washington WI Telephone: (262) Fax: (262) Vicki Kaas Ozaukee County Department of Human Services 121 West Main Street Port Washington WI Telephone: (262) Fax: (262) $ Paid by credit Card $5.00 discount for payment by cash, cashier check or money order $ No Show Fee $ Reassessment Fee $75.00 Amended Assessment Fee $75.00 Transfer or Reassessment Fee 54
55 PEPIN COUNTY Carol Nedland Pepin County Department of Human Services 740 7th Avenue West Durand WI Telephone: (715) Fax: (715) Pam Haukeness, Director Arbor Place st Street NE Menomonie WI Telephone: (715) Fax: (715) $ OWI Assessment Fee $ Failed Appointment / No Show $ Late Canceled Fee (less than 72 hours) 55
56 PIERCE COUNTY Ron Kiesler Pierce County Department of Human Services 412 West Kinne Street P.O. Box 670 Ellsworth WI Telephone: (715) Fax: (715) Reggie Christiansen Pierce County Department of Human Services 412 West Kinne Street P.O. Box 670 Ellsworth WI Telephone: (715) Fax: (715) $ Assessment Fee $ Failed Appointment $ Transfer Fee $ Amendment Fee 56
57 POLK COUNTY Gary Ehrich Polk County Human Services Department 100 Polk Plaza, Suite 50 Balsam Lake WI Telephone: (715) Fax: (715) Gary Ehrich Polk County Human Services Department 100 Polk Plaza, Suite 50 Balsam Lake WI Telephone: (715) Fax: (715) $ Assessment Fee $ No-Show or Canceled With Less Than 24 Hours Notice, Forfeit Fee 57
58 PORTAGE COUNTY Amy Marcott Portage County Health and Human Services 817 Whiting Avenue Stevens Point WI Telephone: (715) Fax: (715) Jessica Hake Portage County Health and Human Services 817 Whiting Avenue Stevens Point WI Telephone: (715) Fax: (715) $ Assessment Fee ($50.00 Deposit) $50.00 Failed Appointment (Loss of Deposit) $50.00 Amendment and/or Extension Fee 58
59 PRICE COUNTY Kathy Billek Price County Dept. of Human Services 104 South Eyder Avenue Phillips WI Telephone: (715) Fax: (715) Arlene Eslinger Community Counseling Services County Hwy X Chippewa Falls WI Telephone: (715) Fax: (715) communitycounselingservicescf@gmail.com $ Assessment Fee ($100 Deposit at Scheduling) $ Failed Appointment $ Amend Driver Safety Plan 59
60 RACINE COUNTY Mary Jane Whitmore, LCSW, CSAC Behavioral Health Services of Racine County Racine County Human Services Department 1717 Taylor Avenue Racine WI Telephone: (262) Fax: (262) Mary Jane Whitmore, LCSW, CSAC Behavioral Health Services of Racine County Racine County Human Services Department 1717 Taylor Avenue Racine WI Telephone: (262) Fax: (262) $ Assessment Fee 60
61 RICHLAND COUNTY Myranda Culver, Clinic Coordinator Richland County Health and Human Services 221 W. Seminary Street Richland Center, WI Telephone: (608) Fax: (608) Louvin Goodman, CSAS Richland County Health and Human Services 221 W. Seminary Street Richland Center, WI Telephone: (608) Fax: (608) $ Assessment Fee $20.00 Failed Appointment $55.00 Amend Driver Safety Plan 61
62 ROCK COUNTY Rebecca Rudolph, MS, LPC w/aoda Authorization Rock County Human Services Department 113 S. Franklin Street P.O. Box 1649 Janesville WI Telephone: (608) Fax: (608) Rebecca Rudolph, MS, LPC w/aoda Authorization Rock County Human Services Department 113 S. Franklin Street P.O. Box 1649 Janesville WI Telephone: (608) Fax: (608) $ Assessment Fee $ Failed Appointment $ Amend Driver Safety Plan $ Out of State Packet 62
63 RUSK COUNTY Jeremy Jacobs Rusk County Health and Human Services 311 East Miner Ave., Suite C240 Ladysmith WI Telephone: (715) Fax: (715) Arlene Eslinger Community Counseling Services County Hwy X Chippewa Falls WI Telephone: (715) Fax: (715) arleneeslinger@sbcglobal.net $ Assessment Fee $50.00 Failed Appointment Fee $50.00 Non-Compliance Fee 63
64 ST CROIX COUNTY Kristin DePrey St Croix County Health and Human Services 1752 Dorset Lane New Richmond WI Telephone: (715) Fax: (715) Mel Solsvig St Croix County Health and Human Services 1752 Dorset Lane New Richmond WI Telephone: (715) Fax: (715) Assessment Scheduling: (715) $ Assessment Fee $ No Show/Late Cancellation $ Amendment to Driver Safety Plan $ Plan extension to complete Driver Safety Plan $ Final Report $45.00 Plan Extension for payment of treatment fees $40.00 Out-of-State Referral 64
65 SAUK COUNTY Betty Kryka, BS, CSAC, IndCS Sauk County Human Services P.O. Box 29 Baraboo, WI Telephone: (608) Fax: (608) Diane Brey Street Clare Center 1510 Jefferson St Baraboo, WI Telephone: (608) Fax: (608) $ Assessment Fee ($75.00 Non-Refundable Deposit) 65
66 SAWYER COUNTY Paul Grahovac, Program Director Sawyer County Human Services Main St., Suite 224 Hayward WI Telephone: (715) Ext 2334 Fax: (715) Joe Bodo, Program Coordinator Sawyer County Human Services Main St., Suite 224 Hayward WI Telephone: (715) Ext 2317 Fax: (715) $ Assessment Fee ($ down to schedule, remaining $ due at appointment) $50.00 No Show/Late cancel Fee $50.00 Amendment Fee 66
67 SHAWANO COUNTY Judy Kressin-Reindl Shawano County Department of Human Services Lakeland Center 504 Lakeland Road Shawano WI Telephone: (715) Fax: (715) Judy Kressin-Reindl Shawano County Department of Human Services Lakeland Center 504 Lakeland Road Shawano WI Telephone: (715) Fax: (715) $ Assessment Fee $ Cancellation Fee (without 48 hours notice) $ Failed Appointment (15 minutes late) $ Amended Driver Safety Plan 67
68 SHEBOYGAN COUNTY Linda Knebel, Coordinator Outpatient Services Sheboygan County Human Services Department 1011 North 8th Street Sheboygan WI Telephone: (920) Fax: (920) Deb Althen, IDP Assistant Outpatient Services Sheboygan County Human Services Department 1011 North 8th Street Sheboygan WI Telephone: (920) Fax: (920) $ Assessment Fee (Forfeit fee if a no-show) 68
69 TAYLOR COUNTY Jen Meyer Taylor County Community Human Services Department 540 East College St. Medford WI Telephone: (715) Fax: (715) Jen Meyer Taylor County Community Human Services Dept. 540 East College St. Medford WI Telephone: (715) Fax: (715) $ Assessment Fee $ Amend Driver Safety Plan or Extension $ Compliance Reinstatement $75.00 Out-of-County Transfer 69
70 TREMPEALEAU COUNTY DeeAnn Anderson, Services Coordinator Trempealeau County Department of Human Services County Courthouse P.O. Box 67 Whitehall WI Telephone: (715) x266 Fax: (715) Nick Lee West Central Behavioral Health Whitehall Road Independence WI Telephone: (866) Telephone: (715) (Spanish) Fax: (715) (Attention: Jean) $ Assessment Fee 70
71 VERNON COUNTY Jean Klousia Vernon County Human Services 318 Fairlane Drive, Suite 100 Viroqua WI Telephone: (608) Fax: (608) Melony Hansen Family & Children s Center 1321 North Main Street P.O. Box 149 Viroqua WI Telephone: (800) Telephone: (608) Fax: (608) mhansen@fccnetwork.org $ Assessment Fee (due prior to appointment) $50.00 Failed Appointment / No-Show $50.00 Non-Compliance Fee $ Month Extension Fee 71
72 VILAS COUNTY Donna M. Shimeck, MA, LCSW The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1256 Fax: (715) ds@thehumanservicecenter.org Jodi Baker, SAC, IDP-AT The Human Service Center Forest / Oneida / Vilas County 705 East Timber Drive P.O. Box 897 Rhinelander WI Telephone: (715) x1229 Fax: (715) jb@thehumanservicecenter.org $ Assessment Fee $ Failed Appointment/Late Cancellation $50.00 Amendment 72
73 WALWORTH COUNTY Carlo Nevicosi Walworth County Health and Human Services W4051 County Road NN P.O. Box 1005 Elkhorn WI Telephone: (262) Fax: (262) Cathy Griffin Walworth County Health and Human Services W4051 County Road NN P.O. Box 1005 Elkhorn WI Telephone: (800) Telephone: (262) Fax: (262) $ Assessment Fee $40.00 Failed Appointment $ Multiple assessment fee (for each additional assessment completed at one time) $75.00 Amend Driver Safety Plan 73
74 WASHBURN COUNTY Al SimonWashburn County Health and Human Services Department P.O. Box 250 Shell Lake WI Telephone: (715) Fax: (715) Arlene Eslinger Community Counseling Services County Hwy X Chippewa Falls WI Telephone: (715) Fax: (715) arleneeslinger@sbcglobal.net $ Assessment Fee 74
75 WASHINGTON COUNTY Jackie Moglowsky, Behavioral Health Manager Washington County Human Services Department 333 East Washington Street W., Suite 2100 West Bend WI Telephone: (262) Fax: (262) Mary Simon Elevate, Inc. W169N21005 Meadow Lane Jackson WI Telephone: (262) Fax: (262) $ Assessment Fee $ Amend Driver Safety Plan $ Reinstatement Fee $ Extend Driver Safety Plan 75
76 WAUKESHA COUNTY John Kettler Waukesha County Health and Human Services 514 Riverview Avenue Waukesha WI Telephone: (262) Fax: (262) Joseph Muchka Addiction Resource Council 741 N. Grand Avenue, Suite 300 Waukesha WI Telephone: (262) Fax: (262) $ Assessment Fee $ No show/reschedule Fee$50 Noncompliance Fee $50.00 Extend Driver Safety Plan $25.00 NSF 76
77 WAUPACA COUNTY Ronald Pehlke Waupaca County Department of Health and Human Services 811 Harding Street Waupaca WI Telephone: (715) Fax: (715) Ronald Pehlke Waupaca County Department of Health and Human Services 811 Harding Street Waupaca WI Telephone: (715) Telephone: (715) (OWI signup) Telephone: (715) Fax: (715) $ Assessment Fee $ Voluntary Client Fee $ Failed Appointment $ Late Fee $ Amend / Extend Driver Safety Plan $50.00 Multiple Assessment Fee (for each additional assessment completed at one time) 77
78 WAUSHARA COUNTY Sue Shemanski Waushara County Department of Human Services 230 West Park Street P.O. Box 1230 Wautoma WI Telephone: (920) Fax: (920) Sue Shemanski Waushara County Department of Human Services 230 West Park Street P.O. Box 1230 Wautoma WI Telephone: (920) Fax: (920) $ Assessment Fee $ Failed Appointment $50.00 Extend Driver Safety Plan 78
79 WINNEBAGO COUNTY Michael Daehn, Ph.D., Chief Psychologist/Clinical Supervisor Winnebago County Department of Human Services 220 Washington Avenue Oshkosh WI Telephone: (920) Fax: (920) IDP Secretary Winnebago County Department of Human Services 220 Washington Avenue Oshkosh WI Telephone: (920) Fax: (920) $ Assessment Fee $ Failed Appointment $ Amend Driver Safety Plan 79
80 WOOD COUNTY Randall Ambrosius, AODA/MH Manager Wood County Unified Services Dept th St. South Wisconsin Rapids WI Telephone: (715) Fax: (715) Randall Ambrosius Wood County Unified Services Dept th St. South Wisconsin Rapids WI Telephone: (715) Fax: (715) $ OWI Assessment fee $80.00 Failed Appointment $85.00 Amend Driver Safety Plan 80
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