Community Substance Abuse Program Certification Directory By County, City, and Provider Name Adams County

Transcription

1 DEPARTMENT OF HEALTH SERVICES Division of Quality Assurance Community Substance Abuse Program Certification Directory By County, City, and Provider Name Adams County STATE OF WISCONSIN Bureau of Health Services PO Box 969 Madison, WI ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: E NORTH STREET FRIENDSHIP, WI 594 Adams County Surveyor: Hannah Whaley DIANE CABLE Initial Cert: 1/10/008 [email protected] Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Lic #: E NORTH STREET FRIENDSHIP, WI 594 Adams County Surveyor: Hannah Whaley DIANE CABLE Initial Cert: 09/01/1990 [email protected] Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 0/01/015 0/9/016 09/9/015 Page 1 of 1

2 Ashland County BAD RIVER AODA PROGRAM 5585 NOKOMIS RD ASHLAND, WI Ashland County Surveyor: Polly Wong Lic #: 78 JOANN WOODHULL Initial Cert: 0/01/007 Phone: (715) /01/015 0/8/017 Fax: (715) CSAS-DAY TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER Lic #: MAPLE LANE ASHLAND, WI Ashland County Surveyor: Polly Wong CONNIE GUDERIAN Initial Cert: 10/01/1999 Phone: (715) /01/01 09/0/015 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/01 09/0/015 10/01/01 09/0/015 10/01/01 09/0/015 10/01/01 09/0/015 10/01/01 09/0/015 10/01/01 09/0/015 10/01/01 09/0/015 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI /01/01 09/0/015 DRUMMOND AREA SCHOOL DISTRICT, 5440 EASTERN AVE, DRUMMOND, WI /18/016 09/0/015 Barron County BARRON COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 640 EAST MONROE AVE, ROOM 8 BARRON, WI 5481 Barron County Surveyor: Roderic Senn JUDY DEMERS Initial Cert: 01/01/006 [email protected] Phone: (715) /01/01 10/1/015 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/01 10/1/015 11/01/01 10/1/015 09/9/015 Page of 1

3 Bayfield County RED CLIFF AODA PROGRAM/MISHOMIS HOUSE 790 N BRADUM ROAD BAYFIELD, WI Bayfield County Surveyor: Polly Wong Lic #: 1781 DR. JOSEPH CORBINE Initial Cert: 11/01/198 [email protected] Phone: (715) /01/014 09/0/016 Fax: (715) CSAS-MEDICALLY MONITORED TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 NORTHLAKES COMMUNITY CLINIC - AODA SERVICES Lic #: US HWY IRON RIVER, WI Bayfield County Surveyor: Polly Wong JASON AKL Initial Cert: 09/01/1984 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) /01/014 08/1/016 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINC-ASHLAND DENTAL CLINIC, 719 MAIN STREET EAST, ASHLAND, WI 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC - WASHBURN, 101 THOMPSON ROAD, WASHBURN, WI /01/015 08/1/016 NORTHLAKES COMMUNITY CLINIC-ASHLAND AODA CLINIC, 50 W MAIN ST, SUITE 05, ASHLAND, WI 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC-HAYWARD DENTAL CLINIC, 15910W COMPANY LAKE RD, HAYWAR 10/01/014 01/18/015 NORTHLAKES COMMUNITY CLINIC-HAYWARD MEDICAL CLINIC, 1118N STATE HIGHWAY 77, HAYWAR 10/01/014 08/1/016 NORTHLAKES COMMUNITY CLINIC-MINONG MEDICAL CLINIC, 600 SHELL CREEK ROAD, MINONG, WI 10/01/014 08/1/016 ASHLAND HIGH SCHOOL, 1900 BEASER AVENUE, ASHLAND, WI ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI BAD RIVER HEAD START, 5759 PINE STREET, ODANAH, WI LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI /01/015 08/1/016 10/01/015 08/1/016 10/01/015 08/1/016 10/01/015 08/1/016 NEW HORIZONS NORTH CCS - BAYFIELD COUNTY Lic #: WEST BAYFIELD STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong VAL LEVNO Initial Cert: 01/01/015 [email protected] Phone: (715) /01/015 1/1/015 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 01/01/015 1/1/015 09/9/015 Page of 1

4 NORTHLAND COUNSELING SERVICES 1 W OMAHA STREET WASHBURN, WI Bayfield County Surveyor: Polly Wong Lic #: 61 JEREMY KOEHL Initial Cert: 07/01/001 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) /01/014 06/0/016 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI /01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI /01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI /01/014 06/0/016 09/9/015 Page 4 of 1

5 Brown County RIVERSIDE PSYCHIATRIC GROUP SC 15 ANGELS PATH DE PERE, WI Brown County Lic #: 64 RACHEL SCHUTT Initial Cert: 1/01/000 Phone: (90) /01/015 1/1/016 Fax: (90) /01/015 1/1/016 01/01/015 1/1/016 ACS CLINICAL SERVICES, LLC - GREEN BAY 670 UNIVERSITY AVE GREEN BAY, WI 5411 Brown County Lic #: 09 KATRINA NELSON Initial Cert: 07/16/014 [email protected] Phone: (90) /01/015 06/0/016 Fax: (90) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 06/0/016 AMERICAN FOUNDATION OF COUNSELING SERVICES, INC. Lic #: E WALNUT STREET #706 GREEN BAY, WI 5401 Brown County JILL BECK Initial Cert: 04/01/1981 [email protected] Phone: (90) /01/014 04/0/016 Fax: (90) /01/014 04/0/016 05/01/014 04/0/016 1 GOLDEN HOUSE, 110 UNIVERSITY AVE, GREEN BAY, WI /01/014 04/0/016 1 HOUSE OF HOPE, 1660 CHRISTIANA ST., GREEN BAY, WI /01/014 04/0/016 1 MICAH CENTER, 700 E. WALNUT ST., GREEN BAY, WI /01/015 04/0/016 1 NEW COMMUNITY CLINIC - NWTC, 740 W. MASON ST., GREEN BAY, WI /1/015 04/0/016 1 NEW COMMUNITY CLINIC, 6 BODART ST, GREEN BAY, WI /1/015 04/0/016 1 OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI /01/015 04/0/016 NEW COMMUNITY SHELTER, 01 MATHER ST, GREEN BAY, WI /01/015 04/0/016 BAETEN COUNSELING & CONSULTATION TEAM, S.C Lic #: S WEBSTER AVE, SUITE B GREEN BAY, WI 5401 Brown County TINA BAETEN Initial Cert: 08/06/014 [email protected] Phone: (90) /01/015 07/1/017 Fax: (90) /01/015 07/1/017 08/01/015 07/1/017 09/9/015 Page 5 of 1

6 BELLIN PSYCHIATRIC CENTER 01 E ST JOSEPH STREET GREEN BAY, WI 5405 Brown County Lic #: 1098 STEVE DUSCHER Initial Cert: 04/01/1984 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) 41-0 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 0/1/015 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - ALGOMA, 81 PARKER ST, ALGOMA, WI /04/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - BRILLION, 964 W. RYAN ST., STE. B, BRILLION, WI /0/015 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 575-4TH ST, KEWAUNEE, WI /01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 704 S. WEBSTER STE. #01, GREEN BAY, WI /01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI /01/014 0/1/016 BELLIN PSYCHIATRIC CENTER - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI BELLIN PSYCHIATRIC CENTER - OCONTO FALLS, 8 MAIN STREET, OCONTOFALLS, WI BELLIN PSYCHIATRIC CENTER-NEURO TEAM, 75 S WEBSTER, GREEN BAY, WI 5405 BELLIN PSYCHIATRIC CENTER-W. DE PERE, 1800 LAWRENCE DR, DE PERE, WI DR. ROSA MINOKA-HILL SCHOOL, 5 N ROOSEVELT, GREEN BAY, WI /0/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 1/04/014 0/1/016 BROWN COUNTY COMMUNITY TREATMENT CENTER Lic #: GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/015 08/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. MENTAL HEALTH-INPATIENT DHS /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI /01/015 08/1/017 BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 08/5/005 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/014 08/1/016 09/01/014 08/1/016 09/9/015 Page 6 of 1

7 BROWN COUNTY HUMAN SERVICES - DIVERSION Lic #: DANZ AVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 0/01/011 [email protected] Phone: (90) /01/014 01/1/016 Fax: (90) CSAS-RESIDENTIAL INTOXICATION MONITORING DHS /01/014 01/1/016 FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: CROOKS STREET GREEN BAY, WI 5401 Brown County LOIS MISCHLER Initial Cert: 01/1/1996 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) /01/014 0/1/016 04/01/014 0/1/016 1 BILLIE KRESS CENTER - YOUTH DEVELOPMENT, 40 SPIRIT WAY, GREEN BAY, WI /01/014 0/1/016 1 FAMILY SERVICES - SOUTH IRWIN, 66 S IRWIN AVENUE, GREEN BAY, WI /0/014 0/1/016 1 WILLOW TREE, 50 S MONROE STREET, GREEN BAY, WI /0/014 0/1/016 DR. ROSA MINOKA-HILL SCHOOL, 5 N. ROOSEVELT, GREEN BAY, WI 5401 GREEN BAY ALTERNATIVE SCHOOL, 00 SOUTH BROADWAY ST., GREEN BAY, WI 540 0/04/015 0/1/016 0/04/015 0/04/015 INDEPENDENT ASSESSMENT & COUNSELING SERVICES Lic #: W MASON STREET, #01 GREEN BAY, WI 540 Brown County KENNETH SANN Initial Cert: 06//001 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 07/01/014 06/0/016 JACKIE NITSCHKE CENTER, INC 700 CHERRY STREET GREEN BAY, WI 5401 Brown County Lic #: 988 WILLIAM LABINE Initial Cert: 01/01/01 [email protected] Phone: (90) /01/015 1/1/016 Fax: (90) /01/015 1/1/016 09/9/015 Page 7 of 1

8 JACKIE NITSCHKE CENTER, INC. 60 CHERRY STREET GREEN BAY, WI 5401 Brown County Lic #: 1446 WILLIAM LABINE Initial Cert: 06/05/1990 Phone: (90) /01/015 1/1/016 Fax: (90) CSAS-MEDICALLY MONITORED TREATMENT DHS /01/015 1/1/016 KA'NI KUHLI'YO FAMILY CENTER 640 WEST POINT ROAD GREEN BAY, WI 540 Brown County Lic #: 1454 MARI KRIESCHER Initial Cert: 0/11/199 Phone: (90) /01/015 01/1/017 Fax: (90) /01/015 01/1/017 0/01/015 01/1/017 1 ONEIDA COMMUNITY HEALTH CENTER, 55 AIRPORT DRIVE, ONEIDA, WI /01/015 01/1/017 1 ONEIDA NATION VETERAN'S DEPARTMENT, 14 RIVERDALE DR., ONEIDA, WI /01/015 01/1/017 ONEIDA NATION ELEMENTARY SCHOOL, N715 SEMINARY ROAD, ONEIDA, WI ONEIDA NATION HIGH SCHOOL, N710 SEMINARY ROAD, ONEIDA, WI /01/015 01/1/017 0/01/015 01/1/017 NEW WELLNESS ASSOCIATES, INC. 7 S. RIDGE ROAD GREEN BAY, WI 5404 Brown County Lic #: 1669 PATTY HOWARD Initial Cert: 06/01/199 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) /01/014 05/1/016 06/01/014 05/1/016 1 NEW WELLNESS ASSOCIATES INC, 40 CROOKS AVENUE, KAUKAUNA, WI /01/014 05/1/016 QUALITY ADDICTION MANAGEMENT - QAM 979 ALLIED ST SUITE C GREEN BAY, WI 5404 Brown County Lic #: 487 CHARLES SCHRAUTH Initial Cert: 10/0/00 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-NARCOTIC TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 09/9/015 Page 8 of 1

9 ST. JOSEPH'S HOSPITAL - HOSPITAL SISTERS -THIRD ORDER OF ST FRANCIS DBA LIBERTAS Lic #: DOUSMAN STREET GREEN BAY, WI 540 Brown County BARBARA CONIFF Initial Cert: 09/01/1986 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS /01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 Buffalo County Burnett County ST. CROIX TRIBAL BEHAVIORAL HEALTH CLINIC Lic #: STATE RD 70 WEBSTER, WI 5489 Burnett County Surveyor: Polly Wong SARAH CORMELL Initial Cert: 05/01/000 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) /01/014 04/0/016 05/01/014 04/0/016 1 ROUND LAKE CLINIC, 0-60TH AVENUE, LUCK, WI /01/014 04/0/016 09/9/015 Page 9 of 1

10 Calumet County CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 10/01/1975 Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 CALUMET COUNTY DEPT OF HUMAN SERVICES, 06 S. ONEIDA STREET, APPLETON, WI /01/014 06/0/016 CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 06/1/006 [email protected] Phone: (90) /01/015 06/0/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 10 of 1

11 Chippewa County CHIPPEWA AREA RECOVERY RESOURCE, LSS 17 WEST CENTRAL ST CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn Lic #: 896 MARGARET BEHNKE Initial Cert: 0/09/010 Phone: (715) /01/015 0/8/017 Fax: (715) /01/015 0/8/017 1 CHIPPEWA AREA RECOVERY RESOURCE, 1 S BARSTOW ST SUITE #1, EAU CLAIRE, WI /01/015 0/8/017 COMMUNITY COUNSELING SERVICES COUNTY HIGHWAY X CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn Lic #: 744 ARLENE ESLINGER Initial Cert: 08/14/007 [email protected] Phone: (715) /01/014 07/1/016 Fax: (715) CSAS-INTERVENTION DHS /01/014 07/1/016 ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Lic #: COUNTY HIGHWAY I CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn THERESA MACKEY Initial Cert: 01/1/1977 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 09/9/015 Page 11 of 1

12 WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS Lic #: N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 04/01/015 [email protected] Phone: (715) /01/015 0/1/016 Fax: (715) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 CCS REGIONAL MODEL MULTI-COUNTY W/TELEHEALTH DHS 6 04/01/015 0/1/016 04/01/015 0/1/016 1 BUFFALO COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 407 S. SECOND STREET, ALMA, WI /01/015 0/1/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI /01/015 0/1/016 1 RUSK COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 11 E. MINER STREET, LADYSMITH, WI /01/015 0/1/016 BARRON COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 5 E. MONROE AVE., BARRON, WI 5481 DUNN COUNTY DEPT OF HUMAN SERVICES, 001 US HWY 1 E., STE. 160, MENOMONIE, WI DUNN COUNTY DEPT OF HUMAN SERVICES, 808 MAIN STREET, MENOMONIE, WI PIERCE COUNTY DEPT OF HUMAN SERVICES, 41 W. KINNE STREET, ELLSWORTH, WI POLK COUNTY HUMAN SERVICES DEPARTMENT, 100 POLK COUNTY PLAZA, SUITE 50, BALSAM LAKE 04/01/015 0/1/016 04/1/015 0/1/016 04/01/015 04/1/015 04/01/015 0/1/016 04/01/015 0/1/016 Chisago County (MN) HAZELDEN 1545 PLEASANT VALLEY ROAD CENTER CITY, MN 5501 Chisago County (MN) Surveyor: Roderic Senn Lic #: 198 SCOTT HESSELTINE Initial Cert: 05/01/1988 [email protected] Phone: (651) /01/015 04/0/017 Fax: (651) CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 1 of 1

13 Clark County CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET RM 50 NEILLSVILLE, WI Clark County Surveyor: Roderic Senn Lic #: 101 RUSSELL GIRARD Initial Cert: 01/01/1984 Phone: (715) /01/014 1/1/015 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 CLARK COUNTY HEALTH CARE CENTER, W466 STATE HWY 9, OWEN, WI /01/014 1/1/015 GRANTON SCHOOL DISTRICT, 17 N. MAIN STREET, GRANTON, WI 5446 NEILLSVILLE ELEMENTARY SCHOOL, 405 EAST 5TH STREET, NEILLSVILLE, WI NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI /10/015 1/1/015 01/7/015 1/1/015 01/7/015 1/1/015 CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET, ROOM 50 NEILLSVILLE, WI Clark County Surveyor: Roderic Senn Lic #: 09 SUE VOIGT Initial Cert: 09/01/015 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/015 08/1/016 09/01/015 08/1/016 09/9/015 Page 1 of 1

14 Columbia County COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: MURPHY ROAD PORTAGE, WI 5901 Columbia County Surveyor: Erin Taylor DAWN WOODARD Initial Cert: 04/01/010 Phone: (608) /01/015 0/1/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS Lic #: HUNTERS TRAIL PORTAGE, WI 5901 Columbia County Surveyor: Hannah Whaley DR. JOCELYN MILLER PHD Initial Cert: 10/08/1999 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) /01/015 06/0/016 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 100 LINCOLN AVE, BARABOO, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 19 PARK AVENUE, COLUMBUS, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 95 US HIGHWAY 14 WEST, RICHLAND CENTER, 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 50 PRAIRIE AVE, PRAIRIE DU SAC, WI /01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 710 NORTH WEBB AVE STE 400, REEDSBURG, WI 07/01/015 06/0/016 Crawford County MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER INC.- VILLA SUCCES Lic #: S. PRAIRIE STREET PRAIRIE DU CHIEN, WI 581 Crawford County Surveyor: Cynthia Lindgren MS LACIE ANTHONY Initial Cert: 01/01/1987 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS /01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 14 of 1

15 Dane County ARC - MATERNAL AND INFANT PROGRAM 40 MONONA DRIVE MADISON, WI 5716 Dane County Surveyor: Erin Taylor Lic #: 04 LINDA VAN TOL Initial Cert: 08/01/014 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 07/1/017 ARC COMMUNITY SERVICES, INC. MADISON 1409 EMIL STREET, #100 MADISON, WI 571 Dane County Surveyor: Erin Taylor Lic #: 105 LAURA FABICK Initial Cert: 0/01/1995 [email protected] Phone: (608) /01/015 0/8/017 Fax: (608) CSAS-DAY TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 1 DAY REPORTING CENTER, 7017 RAYWOOD ROAD, MADISON, WI 571 0/01/015 0/8/017 1 SUMMIT CREDIT UNION COMMUNITY ROOM, 1 W MAIN STREET, SUN PRAIRIE, WI /01/015 0/8/017 ARC HOUSE 0 N. PATERSON STREET MADISON, WI 570 Dane County Surveyor: Hannah Whaley Lic #: 1054 CELESTA MILLER Initial Cert: 1/01/1990 [email protected] Phone: (608) /01/01 11/0/015 Fax: (608) 8-64 CSAS-MEDICALLY MONITORED TREATMENT DHS /01/01 11/0/015 ATTIC CORRECTIONAL SERVICES, INC. ACS CLINICAL SERVICES Lic #: S. PARK STREET SUITE 1 MADISON, WI 571 Dane County Surveyor: Erin Taylor TIFFANY WALKER Initial Cert: 0/5/010 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-INTERVENTION DHS /01/015 0/1/017 09/9/015 Page 15 of 1

16 CONNECTIONS COUNSELING 5005 UNIVERSITY AVE STE #100 MADISON, WI 5705 Dane County Surveyor: Erin Taylor Lic #: 407 SHELLY DUTCH Initial Cert: 01/01/00 Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 04/01/015 0/1/017 1 JEFFERSON CO HUMAN SVS-CONNECTIONS CNSLG, 1541 ANNEX RD, JEFFERSON, WI /01/015 0/1/017 DANE COUNTY HUMAN SERVICES CCS 10 NORTHPORT DRIVE MADISON, WI 5704 Dane County Surveyor: Hannah Whaley Lic #: 06 CARRIE SIMON Initial Cert: 07/01/015 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL POPULATION-BASED DHS 6 07/01/015 06/0/016 DANE COUNTY DHS - NEIGHBORHOOD INTERVENTION OFFICE, 17 N SHERMAN AVE, MADISON, WI 07/01/015 06/0/016 EXODUS PREVENTION SERVICES, GENESIS SOCIAL SERVICES CORPORATION Lic #: W BELTLINE HIGHWAY, #15 MADISON, WI 571 Dane County Surveyor: William Rohner PAT CARRUTHERS Initial Cert: 1/01/006 Pcarruthers@genesissocialservices Phone: (608) /01/015 1/1/016 Fax: (608) CSAS-INTERVENTION DHS CSAS-PREVENTION DHS /01/015 1/1/016 01/01/015 1/1/016 FAMILY SERVICE OF MADISON, INC. 18 E. OLIN AVENUE, #100 MADISON, WI 571 Dane County Surveyor: Hannah Whaley Lic #: 17 DAVID JOHNSON Initial Cert: 04/01/1977 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) 5-1 CSAS-PREVENTION DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 09/9/015 Page 16 of 1

17 HOPE HAVEN-REBOS UNITED, INC - CHRIS FARLEY HOUSE Lic #: W. OLIN AVENUE MADISON, WI 5715 Dane County Surveyor: Erin Taylor FRAN AUGUSTINE Initial Cert: 10/01/199 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 JESSIE CRAWFORD RECOVERY CENTER, INC 148 NORTH SHERMAN AVE MADISON, WI 5704 Dane County Surveyor: Erin Taylor Lic #: 986 JAMES CRAWFORD Initial Cert: 11/0/01 [email protected] Phone: (608) /01/014 10/1/016 Fax: (608) CSAS-DAY TREATMENT DHS /01/014 10/1/016 11/01/014 10/1/016 JOURNEY MENTAL HEALTH CENTER INC 65 W WASHINGTON AVE MADISON, WI 570 Dane County Surveyor: Hannah Whaley Lic #: 1596 LYNN BRADY Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 0/9/016 Fax: (608) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/014 0/9/016 01/1/015 0/9/016 0/01/014 0/9/016 01/1/015 0/9/016 DEFOREST AREA MIDDLE SCHOOL, 404 YORKTOWN ROAD, DE FOREST, WI 55 05/7/015 06/11/015 SENNETT MIDDLE SCHOOL, 50 PFLAUM ROAD, MADISON, WI /1/015 06/11/015 MADISON HEALTH SERVICES 5109 WORLD DAIRY DRIVE MADISON, WI 5718 Dane County Surveyor: Hannah Whaley Lic #: 1549 STEVE HANUSA Initial Cert: 01/01/1994 [email protected] Phone: (608) /01/015 1/1/015 Fax: (608) CSAS-NARCOTIC TREATMENT DHS /01/015 1/1/015 07/01/015 1/1/015 09/9/015 Page 17 of 1

18 MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM Lic #: S. PARK STREET MADISON, WI 5715 Dane County Surveyor: Erin Taylor SUSAN JANTY Initial Cert: 01/01/1984 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 MERITER NEWSTART OUTPATIENT CLINIC 1015 GAMMON LANE MADISON, WI 5719 Dane County Surveyor: Erin Taylor Lic #: 1617 SUE JANTY Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) /01/014 11/0/016 1/01/014 11/0/016 NORTH BAY LODGE 60 MEMORIAL DRIVE MADISON, WI 5704 Dane County Surveyor: Erin Taylor Lic #: 1674 FRAN AUGUSTINE Initial Cert: 0/01/1984 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 QUALITY ADDICTION MANAGEMENT, INC. 151 E BADGER ROAD #A MADISON, WI 571 Dane County Surveyor: Erin Taylor Lic #: 595 WENDY KOHLHAAS Initial Cert: 07/11/005 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-NARCOTIC TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 18 of 1

19 ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM Lic #: SCIENCE DRIVE RM #110 & 00 MADISON, WI 5711 Dane County Surveyor: Hannah Whaley DAVID GEBAUER Initial Cert: 10/1/010 [email protected] Phone: (608) /01/01 10/1/015 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /0/014 10/1/015 08/0/014 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 SCHWERT AODA TREATMENT CENTER 501 KIPLING DRIVE MADISON, WI 5704 Dane County Surveyor: Erin Taylor Lic #: 186 TODD VIETH Initial Cert: 07/01/199 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 06/0/017 TELLURIAN UCAN 914 INDUSTRIAL DRIVE MADISON, WI 571 Dane County Surveyor: William Rohner Lic #: 1904 SARAH LIM Initial Cert: 04/01/1985 [email protected] Phone: (608) /01/01 10/1/015 Fax: (608) -04 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS /01/01 10/1/015 11/01/01 10/1/015 THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC Lic #: WALL STREET, #500 MADISON, WI 5718 Dane County Surveyor: Hannah Whaley KEVIN RANDALL Initial Cert: 0/01/198 christiancounselingmadison@gmail. Phone: (608) /01/014 0/1/016 Fax: (608) /01/014 0/1/016 0/01/014 0/1/016 09/9/015 Page 19 of 1

20 THE PSYCHOLOGY CLINIC, INC. 10 N MIDVALE BOULEVARD #0 MADISON, WI 5705 Dane County Surveyor: Erin Taylor Lic #: 1919 JAMES BLACK, PHD Initial Cert: 10/01/1991 [email protected] Phone: (608) /01/014 10/1/016 Fax: (608) /01/014 10/1/016 11/01/014 10/1/016 1 AIDS NETWORK, 600 WILLIAMSON STREET, MADISON, WI /01/014 01/1/015 1 THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 1, WISCONSIN DELLS, WI /01/014 10/1/016 THE PSYCHOLOGY CLINIC, INC - BARABOO, 701 ASH STREET, BARABOO, WI 591 THE PSYCHOLOGY CLINIC, INC - PRAIRIE DU SAC, 1190 PRAIRIE STREET, PRAIRIE DU SAC, WI 5578 SAUK PRAIRIE HIGH SCHOOL, 105 NINTH STREET, PRAIRIE DU SAC, WI /01/014 10/1/016 11/01/014 10/1/016 08/5/016 10/1/016 UNIVERSITY OF WI HOSPITALS & CLINICS 1 E. OLIN AVENUE, #75 MADISON, WI 571 Dane County Surveyor: Hannah Whaley Lic #: 1940 CYNTHIA GREEN Initial Cert: 11/01/1990 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) /01/014 01/1/016 0/01/014 01/1/016 UW HEALTH BEHAVIORAL HEALTH & RECOVERY Lic #: SOUTH PARK ST SUITE #400 MADISON, WI 5715 Dane County Surveyor: Erin Taylor MICHAEL WAUPOOSE Initial Cert: 01/01/199 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) /01/014 11/0/016 TELLURIAN OUTPATIENT CLINIC 00 FEMRITE DR - ND FLOOR MONONA, WI 5716 Dane County Surveyor: Erin Taylor Lic #: 1901 SARAH LIM Initial Cert: 04/7/011 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) CSAS-INTERVENTION DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 09/9/015 Page 0 of 1

21 TELLURIAN UCAN, INC. 00 FEMRITE DRIVE MONONA, WI 5716 Dane County Surveyor: William Rohner Lic #: 1900 SARAH LIM Initial Cert: 06/01/199 Phone: (608) /01/014 05/1/016 Fax: (608) -045 CSAS-MEDICALLY MONITORED TREATMENT DHS /01/014 05/1/016 OCEANHAWK COUNSELING ALTERNATIVES, LLC Lic #: W MAIN STREET, #07A STOUGHTON, WI 5589 Dane County Surveyor: William Rohner JEAN DAUTE Initial Cert: 07/17/006 [email protected] Phone: (608) /01/015 06/0/017 Fax: (877) /01/015 06/0/017 07/01/015 06/0/017 STOUGHTON HOSPITAL 900 RIDGE STREET STOUGHTON, WI 5589 Dane County Surveyor: William Rohner Lic #: 1884 HEATHER KLEINBROOK Initial Cert: 09/01/1997 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) 87-9 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 PRAIRIE COUNSELING SERVICES 1460 W. MAIN STREET #6 SUN PRAIRIE, WI 5590 Dane County Surveyor: Erin Taylor Lic #: 174 CATHRYN HUBBARD Initial Cert: 07/01/1978 [email protected] Phone: (608) /01/014 07/1/016 Fax: (608) /01/014 07/1/016 08/01/014 07/1/016 09/9/015 Page 1 of 1

22 Dodge County AFFILIATED COUNSELING CENTER, LLC 108 N LINCOLN AVENUE BEAVER DAM, WI 5916 Dodge County Lic #: 1018 SANDRA SCHWEFEL-MASSIE Initial Cert: 11/01/1989 [email protected] Phone: (90) /01/015 09/0/017 Fax: (90) /01/015 09/0/017 10/01/015 09/0/017 1 AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI /01/015 09/0/017 AGNESIAN HEALTHCARE, D.B.A. PSYCHIATRIC ASSOCIATES Lic #: FRONT STREET, #D BEAVER DAM, WI 5916 Dodge County JIM SALASEK Initial Cert: 10/01/1984 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 07/01/014 06/0/016 WAYLAND ACACDEMY COUNSELING SERVICES - SCHOEN, 101 NORTH UNIVERSITY AVE, BEAVER DA 0/7/015 06/0/016 DODGE COUNTY HUMAN SERVICES & HEALTH DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 1/11/007 [email protected] Phone: (90) /01/01 11/0/015 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 11/0/015 1/01/01 1/1/014 09/9/015 Page of 1

23 DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT Lic #: COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 10/01/1975 Phone: (90) /01/015 0/8/017 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/015 09/0/016 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 LOMIRA SCHOOL, 100 4TH ST., LOMIRA, WI /01/015 0/8/017 MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI /01/015 0/8/017 MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 01, MAYVILLE, WI /01/015 0/8/017 ROCK RIVER INTERMEDIATE SCHOOL, 451 E. SPRING ST. RM 15 B, WAUPUN, WI 596 0/01/015 0/8/017 VAN BRUNT ELEMENTARY, 611 MILL ST. RM 447, HORICON, WI 50 0/01/015 0/8/017 UW HEALTH PARTNERS DIRECTIONS COUNSELING CENTER Lic #: HOSPITAL DRIVE WATERTOWN, WI 5098 Dodge County ERIC D BEAVER Initial Cert: 11/01/1981 [email protected] Phone: (90) /01/014 1/1/015 Fax: (90) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 UW HEALTH PARTNERS LAKE MILLS CLINIC, 105 MULBERRY STREET, LAKE MILLS, WI /01/014 1/1/015 09/9/015 Page of 1

24 Door County COUNSELING ASSOCIATES OF DOOR COUNTY, LLC Lic #: N. 1TH AVENUE STURGEON BAY, WI 545 Door County WILLIAM G NICK Initial Cert: 11/16/199 [email protected] Phone: (90) /01/014 11/0/016 Fax: (90) /01/014 11/0/016 1/01/014 11/0/016 1 COUNSELING ASSOCIATES OF DOOR COUNTY -GB, 0 SOUTH BROADWAY, GREEN BAY, WI 540 1/01/014 11/0/016 1 COUNSELING ASSOCIATES OF DOOR COUNTY, 711 HWY 4, FISH CREEK, WI 541 1/01/014 11/0/016 DR. ROSA MINOKA-HILL SCHOOL, 5 N. ROOSEVELT, GREEN BAY, WI /0/015 11/0/016 DOOR COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: NEBRASKA STREET STURGEON BAY, WI 545 Door County CORI MCFARLANE Initial Cert: 01/01/1978 [email protected] Phone: (90) /01/014 09/0/016 Fax: (90) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 DOOR COUNTY DEPT OF HUMAN SERVICES - CCS Lic #: NEBRASKA STREET STURGEON BAY, WI 545 Door County JOSEPH KREBSBACH Initial Cert: 1/01/014 [email protected] Phone: (90) /01/014 11/0/015 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 1/01/014 11/0/015 09/9/015 Page 4 of 1

25 Douglas County DOUGLAS COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: N 14TH STREET SUITE 400 SUPERIOR, WI Douglas County Surveyor: Polly Wong DAVE LONGSDORF Initial Cert: 01/06/009 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CSAS-INTERVENTION DHS /01/015 1/1/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER Lic #: N 4TH STREET, #00 SUPERIOR, WI Douglas County Surveyor: Polly Wong BETSY BYLER Initial Cert: 1/01/198 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) /01/014 06/0/016 07/01/014 06/0/016 BRYANT ELEMENTARY SCHOOL, 14 CENTRAL AVE, SUPERIOR, WI /01/014 06/0/016 COOPER ELEMENTARY, 1807 MISSOURI AVE., SUPERIOR, WI /0/016 06/0/016 FOUR CORNERS ELEMENTARY, 4465 COUNTY RD. B, SUPERIOR, WI /0/016 06/0/016 GREAT LAKES ELEMENTARY, 19 N. 8TH ST. EAST, SUPERIOR, WI /0/016 06/0/016 LAKE SUPERIOR ELEMENTARY, 600 E. RD ST., SUPERIOR, WI /0/016 06/0/016 NORTHERN LIGHTS ELEMENTARY, 101 NORTH 8TH ST, SUPERIOR, WI /01/014 06/0/016 NORTHWESTERN ELEMENTARY SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI /01/014 06/0/016 NORTHWESTERN HIGH SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI /01/014 06/0/016 NORTHWESTERN MIDDLE SCHOOL, 105 EAST US HWY, POPLAR, WI /01/014 06/0/016 SOLON SPRINGS SCHOOL, 899 EAST BALDWIN AVE, SOLON SPRINGS, WI /01/014 06/0/016 SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI /01/014 06/0/016 SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI /01/014 06/0/016 RIDGEWOOD RECOVERY, INC. DBA THE SUPERIOR TREATMENT CENTER Lic #: TOWER AVENUE, #07 SUPERIOR, WI Douglas County Surveyor: Polly Wong KATHY FETSCH Initial Cert: 0/01/1997 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) /01/015 0/8/017 09/9/015 Page 5 of 1

26 Dunn County ARBOR PLACE, INC KOTHLOW AVE MENOMONIE, WI Dunn County Surveyor: Roderic Senn Lic #: 1050 JILL GAMEZ Initial Cert: 1/01/199 Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-PREVENTION DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 09/9/015 Page 6 of 1

27 Eau Claire County FIRST THINGS FIRST COUNSELING & CONSULTING Lic #: N HILLCREST PKWY STE 01 ALTOONA, WI 5470 Eau Claire County Surveyor: Roderic Senn CHASTITY DRAKE Initial Cert: 09/01/1990 [email protected] Phone: (715) /01/015 07/1/017 Fax: (715) /01/015 07/1/017 08/01/015 07/1/017 AFFINITY HOUSE 04 KILBOURNE AVENUE EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 100 ANITA KUSTER Initial Cert: 0/01/199 [email protected] Phone: (715) /01/014 0/9/016 Fax: (715) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 0/9/016 0/01/014 0/9/016 CAILLIER CLINIC, LTD. 60 STEIN BLVD EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 1119 PAUL CAILLIER Initial Cert: 01/01/198 [email protected] Phone: (715) /18/015 11/0/016 Fax: (715) /18/015 11/0/016 05/18/015 11/0/016 1 CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 10, MENOMONIE, WI /18/015 11/0/016 CAILLIER CLINIC, LTD, 0 NORTH MAIN STREET, RICE LAKE, WI /18/015 11/0/016 EAU CLAIRE ACADEMY, DIVISION OF CLINICARE CORPORATION Lic #: N. DEWEY STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn VERA MATTER Initial Cert: 0/01/1994 [email protected] Phone: (715) /01/015 08/1/017 Fax: (715) CSAS-TRANSITIONAL RESIDENTIAL DHS CSAS-TRANSITIONAL RESIDENTIAL WITH TELEHEALTH HFS /01/015 08/1/017 09/01/015 08/1/017 09/9/015 Page 7 of 1

28 EAU CLAIRE METRO TREATMENT CENTER 000 OXFORD AVE NORTH BLDG EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 57 MARCY HURLBURT Initial Cert: 08/16/004 Phone: (715) /01/014 11/0/016 Fax: (715) CSAS-NARCOTIC TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 GATEWAY COUNSELING, LLC 459 LONDON ROAD EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 08 CHRIS BRAHAN Initial Cert: 0/09/015 Phone: (715) /09/015 01/1/016 Fax: 0/09/015 01/1/016 GREAT LAKES BEHAVIORAL HEALTH 550 NORTH DEWEY STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 99 VERA MATTER Initial Cert: 0/01/01 Phone: (715) /01/015 08/1/017 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 1 GREAT LAKES BEHAVIORAL HEALTH, 1001 WEST LINCOLN AVE, WEST ALLIS, WI 57 09/01/015 08/1/017 1 MILWAUKEE ACADEMY, 9501 WATERTOWN PLANK ROAD, WAUWATOSA, WI 51 09/01/015 08/1/017 LUTHERAN SOCIAL SERVICES-FAHRMAN CENTER Lic #: CRAIG ROAD EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn DAREN DREGNEY Initial Cert: 11/01/1986 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 06/0/016 07/01/014 06/0/016 09/9/015 Page 8 of 1

29 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC Lic #: WHIPPLE STREET EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn KARLENE PHILLIPS Initial Cert: 06/01/1981 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 MAYO CLINIC HEALTH SYSTEM EAU CLAIRE 11 WHIPPLE STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 151 CINDY MING Initial Cert: 10/01/1981 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) 88-0 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM - OSSEO, 105-8TH STREET, OSSEO, WI /07/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM-BLOOMER CLINIC, 1501 THOMPSON STREET, BLOOMER, WI /01/015 1/1/016 MAYO CLINIC HEALTH SYSTEM NORTHLAND, 1 S MAIN STREET, RICE LAKE, WI MAYO CLINIC HEALTH SYSTEMS - CHIPPEWA FALLS OFFICE, 611 1ST AVENUE, CHIPPEWA FALLS, WI 01/01/015 1/1/016 01/01/015 1/1/016 OMNE CLINIC INC. DBA ECP 101 NORTH FARWELL STREET, STE 04 EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn Lic #: 170 ANTON SMETS Initial Cert: 10/01/1987 info@eauclairecommunityprograms. Phone: (715) /01/014 09/0/016 Fax: (715) CSAS-INTERVENTION DHS /01/014 09/0/016 SACRED HEART HOSPITAL 900 W. CLAIREMONT AVENUE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 09 THERESA MACKEY Initial Cert: 0/01/198 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 09/9/015 Page 9 of 1

30 SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER Lic #: HIGHLAND AVE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn MARK BJERKE Initial Cert: 08/01/1990 Phone: (715) /01/014 08/1/016 Fax: (715) /01/014 08/1/016 09/01/014 08/1/016 1 VANTAGE POINT CLINIC & ASSESSMENT CENTER, 54 GOLF ROAD, SUITE #F, EAU CLAIRE, WI /01/015 08/1/016 SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 144 B EAST DIVISION AVE, BARRON, W SYNERGY GROUP EAU CLAIRE DBA VANTAGE POINT CLINIC, 40 S BARSTOW STREET, #, EAU CLAI CAMERON HIGH SCHOOL, 750 S 1ST STREET, CAMERON, WI 548 CAMERON MIDDLE SCHOOL, 700 S 1ST STREET, CAMERON, WI 548 MANZ ELEMENTARY SCHOOL, 1000 E FILLMORE AVE, EAU CLAIRE, WI PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI ROBBINS ELEMENTARY, 8 E. HAMILTON AVE, EAU CLAIRE, WI WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVENUE, BARRON, WI /01/014 08/1/016 09/01/014 08/1/016 09/10/014 08/1/015 10/1/014 08/1/015 09/01/014 08/1/015 09/01/014 08/1/015 10/1/014 08/1/015 09/01/014 08/1/015 09/10/014 08/1/015 TRINITEAM, INC. 0 GRAHAM AVENUE EAU CLAIRE, WI Eau Claire County Surveyor: Roderic Senn Lic #: 196 ROBERT PEITZMAN Initial Cert: 0/01/1989 [email protected] Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 1 BUFFALO CO COURTHOUSE- DHS TRINITEAM, 407 SOUTH SECOND ST, ALMA, WI /01/014 0/1/016 09/9/015 Page 0 of 1

31 Fond Du Lac County BEACON HOUSE 166 SOUTH PARK AVENUE FOND DU LAC, WI 5496 Fond Du Lac County Lic #: 1085 MARY GERLACH Initial Cert: 05/8/199 Phone: (90) /01/014 05/1/016 Fax: (90) 9-40 CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 05/1/016 BLANDINE HOUSE, INC. 5 N. PARK AVENUE FOND DU LAC, WI 5495 Fond Du Lac County Lic #: 1108 DAVID ENGEBREGTSEN Initial Cert: 01/08/1991 [email protected] Phone: (90) /01/014 1/1/015 Fax: (90) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 1/1/015 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS Lic #: E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/01/1978 [email protected] Phone: (90) /01/014 1/1/015 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS Lic #: E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/18/006 [email protected] Phone: (90) /01/015 07/1/017 Fax: (90) COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 08/01/015 07/1/017 09/9/015 Page 1 of 1

32 PREMIER CARE OF WISCONSIN, LLC WEST SCOTT ST FOND DU LAC, WI 5495 Fond Du Lac County Lic #: 075 ERIN ELLIS Initial Cert: 05/05/015 Phone: (90) /05/015 04/0/016 Fax: (800) CSAS-NARCOTIC TREATMENT DHS /05/015 04/0/016 05/05/015 04/0/016 ST. AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES Lic #: EAST DIVISION STREET FOND DU LAC, WI 5495 Fond Du Lac County JAMES SALASEK PHD Initial Cert: 05/01/1980 Phone: (90) /01/014 1/1/015 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 ST AGNES HOSPITAL BEHAVIORAL HEALTH SVS, 60 BROWN STREET, WAUPUN, WI /01/014 1/1/015 ST AGNES HOSPITAL BEHAV HLTH, 790 EASTGATE DRIVE, RIPON, WI ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI /01/014 06/18/015 06/19/015 1/1/015 09/9/015 Page of 1

33 Forest County FOREST COUNTY POTAWATOMI AODA DEPARTMENT Lic #: KAK YOT LANE CRANDON, WI 5450 Forest County TINA GARCIA Initial Cert: 04/01/015 Phone: (715) /01/015 0/1/016 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS /01/015 0/1/016 04/01/015 0/1/016 SOKAOGON CHIPPEWA HEALTH CLINIC 144 VAN ZILE ROAD CRANDON, WI 5450 Forest County Lic #: 194 PAULETTE SMITH Initial Cert: 0/8/000 Phone: (715) /01/015 1/1/015 Fax: (715) /01/015 1/1/015 0/01/015 1/1/015 Grant County UNIFIED COMMUNITY SERVICES 00 W ALONA LANE LANCASTER, WI 581 Grant County Surveyor: Cynthia Lindgren Lic #: 194 CHERYL KNAPP Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page of 1

34 Green County GREEN COUNTY HUMAN SERVICES N15 STATE ROAD 81 MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren Lic #: 188 GREG HOLCOMB Initial Cert: 10/01/1975 Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 GREEN/LAFAYETTE REGIONAL COMPREHENSIVE COMMUNITY SERVICES Lic #: 085 N15 STATE RD 81 MONROE, WI 5566 Green County Surveyor: Cynthia Lindgren SHARON FARREY Initial Cert: 06/01/015 Phone: (608) /01/015 05/1/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 06/01/015 05/1/016 1 GREEN/LAFAYETTE REGIONAL CCS AT LAFAYETTE CTY HS, 67 MAIN ST., DARLINGTON, WI /01/015 05/1/016 09/9/015 Page 4 of 1

35 Green Lake County GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: COUNTY ROAD A GREEN LAKE, WI Green Lake County Surveyor: Erin Taylor JANA TETZLAFF Initial Cert: 04/01/1977 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS CSAS-PREVENTION WITH TELEHEALTH DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 11/01/014 10/1/016 0/0/015 10/1/016 GREEN LAKE COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES Lic #: COUNTY ROAD A GREEN LAKE, WI Green Lake County Surveyor: Hannah Whaley JANA TETZLAFF Initial Cert: 08//005 [email protected] Phone: (90) /01/015 0/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 10/01/015 0/1/016 10/01/015 0/1/016 Hennepin County (MN) HAZELDEN CENTER FOR YOUTH & FAMILIES TH AVENUE, NORTH PLYMOUTH, MN Hennepin County (MN) Surveyor: Roderic Senn Lic #: 199 SCOTT HESSELTINE Initial Cert: 0/01/1990 [email protected] Phone: (76) /01/015 04/0/017 Fax: (651) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 5 of 1

36 Iowa County UNIFIED COMMUNITY SERVICES 11 PROFESSIONAL DRIVE DODGEVILLE, WI 55 Iowa County Surveyor: Cynthia Lindgren Lic #: 194 CHERYL KNAPP Initial Cert: 10/01/1975 Phone: (608) /01/015 06/0/017 Fax: (608) /01/015 06/0/017 07/01/015 06/0/017 Iron County IRON COUNTY HUMAN SERVICES - CCS 00 TACONTE STREET - SUITE 01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong Lic #: 079 CAROLYN KOLSON-JANOV Initial Cert: 07/01/015 [email protected] Phone: (715) /01/015 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES Lic #: TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/00 [email protected] Phone: (715) /01/015 0/8/017 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS CSAS-PREVENTION WITH TELEHEALTH DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 04/01/015 0/8/017 1 IRON COUNTY HUMAN SERVICES DEPT & ASSOC, 567 RAILROAD STREET, MERCER, WI /01/015 0/8/017 HURLEY SCHOOL DISTRICT, 550 W RANGE VIEW DR, HURLEY, WI 5454 MERCER SCHOOL DISTRICT, 690 W MARGARET STREET, MERCER, WI /01/015 0/8/017 04/01/015 0/8/017 09/9/015 Page 6 of 1

37 Jackson County HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH Lic #: 141 W9850 AIRPORT RD BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn TERRY GREENDEER Initial Cert: 05/01/199 Phone: (715) /01/014 10/1/016 Fax: (715) /01/014 10/1/016 11/01/014 10/1/016 NEKOOSA HEALTH OFFICE, 15 1ST STREET, NEKOOSA, WI /01/014 10/1/016 THREE RIVERS HOUSE, 74 MAIN STREET, LA CROSSE, WI /01/014 10/1/016 TOMAH HEALTH OFFICE, 774 HWY 1 EAST, TOMAH, WI /01/014 10/1/016 WELLNESS CENTER HEALTH OFFICE, S845 WHITE EAGLE ROAD, BARABOO, WI /01/014 10/1/016 WITTENBERG HEALTH OFFICE, N740 HWY 49 NORTH, WITTENBERG, WI /01/014 10/1/016 JACKSON COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: HIGHWAY 54 WEST BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn HEATHER L. HAINZ Initial Cert: 01/01/01 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) /01/015 08/1/016 09/01/015 08/1/016 KROHN CLINIC, LTD. 610 W ADAMS STREET BLACK RIVER FALLS, WI Jackson County Surveyor: Roderic Senn Lic #: 147 SHERIE SPAULDING BH MGR Initial Cert: 0/01/1988 [email protected] Phone: (715) /01/015 04/0/017 Fax: (715) /01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 7 of 1

38 Jefferson County JEFFERSON COUNTY HUMAN SERVICES 1541 ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner Lic #: 1449 KATHI CAULEY Initial Cert: 10/01/1975 Phone: (90) /01/014 05/1/016 Fax: (90) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 06/01/014 05/1/016 06/01/014 05/1/016 06/01/014 05/1/016 JEFFERSON COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner KIMBERLY PROPP Initial Cert: 0/15/006 Phone: (90) /01/015 0/8/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 FAMILY RESOURCES ASSOCIATES, INC. 115 W. MAIN STREET WATERTOWN, WI 5094 Jefferson County Surveyor: William Rohner Lic #: 16 NIKKI KUEFFER Initial Cert: 11/01/199 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) /01/014 10/1/016 11/01/014 10/1/016 FAMILY RESOURCES ASSOCIATES INC, 1 N MAIN STREET, LAKE MILLS, WI /01/014 10/1/016 09/9/015 Page 8 of 1

39 Juneau County JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: E LACROSSE STREET MAUSTON, WI 5948 Juneau County Surveyor: Hannah Whaley JOANN GEIGER Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: E LA CROSSE STREET RM # MAUSTON, WI 5948 Juneau County Surveyor: Erin Taylor JOANN GEIGER Initial Cert: 04/01/01 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 09/9/015 Page 9 of 1

40 Kenosha County COMPASSIONATE CARE COUNSELING (A DIV OF COMPETITIVE EDGE EMP ASSURANCE SVS) Lic #: TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner KEVIN M ORLAKIS Initial Cert: 06/01/00 [email protected] Phone: (6) /01/014 05/1/016 Fax: (6) /01/014 05/1/016 GENESIS BEHAVIORAL SERVICES OPTIONS RESIDENTIAL PROGRAM Lic #: TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/14/000 [email protected] Phone: (6) /01/014 0/1/016 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 0/1/016 04/01/014 0/1/016 HOPE COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC. Lic #: SIXTH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner GUIDA BROWN Initial Cert: 0/15/1990 [email protected] Phone: (6) /01/015 0/8/017 Fax: (6) CSAS-INTERVENTION DHS /01/015 0/8/017 KARE CENTER TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner Lic #: 1014 KARI FOSS Initial Cert: 10/10/1987 [email protected] Phone: (6) /01/014 07/1/016 Fax: (6) CSAS-RESIDENTIAL INTOXICATION MONITORING DHS /01/014 07/1/016 KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: SHERIDAN RD #100 KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATIE HANKS Initial Cert: 05/01/005 [email protected] Phone: (6) /01/015 04/0/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 05/01/015 04/0/017 KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), TH AVENUE, KENOSHA, WI /01/015 04/0/017 09/9/015 Page 40 of 1

41 MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. Lic #: SHERIDAN ROAD, # KENOSHA, WI 514 Kenosha County Surveyor: William Rohner TONY MOORE Initial Cert: 09/14/005 [email protected] Phone: (6) /01/015 09/0/017 Fax: (6) CSAS-DAY TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 OAKWOOD CLINICAL ASSOCIATES, LTD TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 08 AMY ANDERSON Initial Cert: 0/5/1991 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) /01/014 0/9/016 0/01/014 0/9/016 OAKWOOD CLINICAL ASSOCIATES LTD, TH ST, PADDOCK LAKE, WI /01/014 0/9/016 PROFESSIONAL SERVICES GROUP, INC RD STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 1749 BRIAN WOLF Initial Cert: 06/01/198 [email protected] Phone: (6) /01/014 0/1/016 Fax: (6) /01/014 0/1/016 04/01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 116 S 70TH STREET # 508, WEST ALLIS, WI /01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 14 NORTH 8TH AVE, WEST BEND, WI /01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 565 MILWAUKEE AVE., BURLINGTON, WI /01/015 0/1/016 PROFESSIONAL SERVICES GROUP, 800 GOOLD, RACINE, WI /9/014 0/1/016 PSYCHIATRIC AND PSYCHOTHERAPY CLINIC 601-0TH AVENUE, #10 KENOSHA, WI 5144 Kenosha County Surveyor: William Rohner Lic #: 175 PAUL DEFAZIO Initial Cert: 06/01/1980 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) /01/014 04/0/016 05/01/014 04/0/016 09/9/015 Page 41 of 1

42 ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM Lic #: TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner JODY PAHLAVAN PSY.D. Initial Cert: 04/8/00 [email protected] Phone: (6) /01/014 04/0/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 Kewaunee County KEWAUNEE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON, PHD Initial Cert: 0/01/1977 [email protected] Phone: (90) /01/015 01/1/017 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 KEWAUNEE COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON Initial Cert: 0/11/008 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 1/01/014 0/1/016 04/01/014 11/0/014 09/9/015 Page 4 of 1

43 La Crosse County ACS CLINICAL SERVICES, LLC - LA CROSSE 811 ROSE STREET LA CROSSE, WI 5460 La Crosse County Surveyor: Roderic Senn Lic #: 006 BRIDGET TODD-ROBBINS Initial Cert: 08/01/01 [email protected] Phone: (608) /01/015 07/1/017 Fax: (608) CSAS-INTERVENTION DHS /01/015 07/1/017 08/01/015 07/1/017 COULEE COUNCIL ON ADDICTIONS, INC. 91 WEST AVENUE SOUTH LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 140 LORIE LAUTZ Initial Cert: 11/01/1986 [email protected] Phone: (608) /01/014 10/1/016 Fax: (608) CSAS-PREVENTION DHS /01/014 10/1/016 11/01/014 10/1/016 1 YWCA OPHELIA HOUSE, 17 S 7TH STREET, LA CROSSE, WI /01/014 10/1/016 DRIFTLESS RECOVERY SERVICES INC 444 MAIN ST SUITE 01 LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 01 BRETT KNUTSON Initial Cert: 04/14/014 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) /01/015 0/1/017 04/01/015 0/1/017 FAMILY AND CHILDREN'S CENTER 1707 MAIN STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 115 VANESSA SOUTHWORTH Initial Cert: 0/01/1994 [email protected] Phone: (608) /01/01 10/1/015 Fax: (608) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 FAMILY AND CHILDREN'S CENTER, 11 NORTH MAIN ST, VIROQUA, WI /01/01 10/1/015 FAMILY AND CHILDREN'S CENTER, 409 COUNTY RD R, BLACK RIVER FALLS, WI /01/01 11/7/01 09/9/015 Page 4 of 1

44 GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH Lic #: SOUTH AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/1984 Phone: (608) /01/014 11/0/016 Fax: (608) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1 GUNDERSEN CLINIC LTD,, ERVIN STREET, WHITEHALL, WI /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 6 NORTH ND STREET, LA CRESCENT, MN /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 805 MAIN AVE SOUTH, HARMONY, MN /01/014 11/0/016 1 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA /01/014 11/0/016 1 GUNDERSON CLINIC LTD, 5791 OSSEO ROAD, INDEPENDENCE, WI /01/014 11/0/016 1 GUNDERSON CLINIC LTD, 40 SOUTH PETERSON AVE, BLAIR, WI /01/014 11/0/016 1 LA CROSSE CO LAKEVIEW HEALTH CENTER, 90 GARLAND STREET, E, WEST SALEM, WI /01/014 11/0/016 1 RICHLAND MEDICAL CENTER, 01 EAST ND STREET, RICHLAND CENTER, WI /01/014 11/0/016 1 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI /01/014 11/0/016 GUNDERSEN CLINIC LTD, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 581 GUNDERSEN CLINIC, LTD, 180 STATE HWY 9, DECORAH, IA 5101 GUNDERSEN CLINIC, LTD, 601 N SUPERIOR, TOMAH, WI GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI GUNDERSEN LUTHERAN MEDICAL CENTER, 1-16TH AVE SOUTH, ONALASKA, WI GUNDERSEN LUTHERAN MEDICAL CENTER, 111 GUNDERSEN DRIVE, ONALASKA, WI /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH Lic #: SOUTH AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/198 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-NARCOTIC TREATMENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 1-16TH AVENUE SOUTH, ONALASKA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, ERVIN STREET, WHITEHALL, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 111 GUNDERSEN DRIVE, ONALASKA, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI /01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 610 E TAYLOR STREET, PRAIRIE DU CHIEN, WI 581 1/01/014 11/0/016 09/9/015 Page 44 of 1

45 GUNDERSEN LUTHERAN MEDICAL CENTER, INC. UNITY HOUSE FOR MEN Lic #: MILLER STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/199 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR MEN Lic #: MILLER STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/008 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR WOMEN Lic #: FIFTH AVENUE, SOUTH LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 11/01/199 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 HIAWATHA VALLEY MENTAL HEALTH CENTER 19 MAIN STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 97 JULIE HANSON Initial Cert: 0/01/011 Phone: (608) /01/015 0/8/017 Fax: (608) CSAS-INTERVENTION DHS CSAS-PREVENTION DHS /01/015 0/8/017 0/01/015 0/8/017 09/9/015 Page 45 of 1

46 LA CROSSE COUNTY HUMAN SERVICES 00 N 4TH STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 1488 BEV TRUSSONI Initial Cert: 0/01/1978 btrussoni@@lacrossecounty.org Phone: (608) /01/014 04/0/016 Fax: (608) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 1 CRISIS ASSESSMENT RECOVERY EMPOWERMENT, 4647 MORMON COULEE ROAD, LA CROSSE, WI 5 05/01/014 04/0/016 1 RAVENWOOD, 90 GARLAND ST. EAST, WEST SALEM, WI /01/015 04/0/016 LA CROSSE COUNTY HUMAN SERVICES VINE STREET, ROOM 740 LA CROSSE, WI La Crosse County Surveyor: Roderic Senn Lic #: 95 BECKY SPANJERS Initial Cert: 01/19/011 [email protected] Phone: (608) /01/014 04/0/016 Fax: (608) CSAS-INTERVENTION DHS /01/014 04/0/016 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN HEALTHCARE Lic #: WEST AVENUE LA CROSSE, WI La Crosse County Surveyor: Roderic Senn NAN ANDERSON Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 46 of 1

47 MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC Lic #: 16 1 S 11TH STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn LACIE ANTHONY Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 05/1/017 Fax: (608) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS /01/015 05/1/017 06/01/015 05/1/017 06/01/015 05/1/017 06/01/015 10/04/015 MAYO CLINIC FRANCISCAN - ARCADIA, 464 SOUTH ST JOSEPH AVE, ARCADIA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 10 MAIN STREET, HOLMEN, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - PRAIRIE DU CHIEN CLINIC, 800 E BLACKHAWK AVENUE, PRAIRIE DU CH 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SCARSETH HOUSE, 55 S 17TH STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - SIENA HALL, 608 S 11TH STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - SPARTA, 10 W. MAIN ST, SPARTA, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - TOMAH, 5 BUTTS AVENUE, TOMAH, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - VILLA SUCCES, 11 PRAIRIE STREET, PRAIRIE DU CHIEN, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN - WOMEN'S LAAR HOUSE, 1005 JACKSON STREET, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 700 WEST AVENUE SOUTH, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI /01/015 05/1/017 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER, INC.- SCARSETH HOUSE Lic #: S. 17TH STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn SALLY SIBBALD Initial Cert: 01/01/1991 [email protected] Phone: (608) /01/015 0/1/017 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 0/1/017 04/01/015 0/1/017 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC - WOMEN'S LAAR HOUSE Lic #: JACKSON STREET LA CROSSE, WI La Crosse County Surveyor: Roderic Senn JULIE CONWAY Initial Cert: 0/19/004 [email protected] Phone: (608) /01/014 0/1/016 Fax: (608) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 0/1/016 04/01/014 0/1/016 09/9/015 Page 47 of 1

48 WESTERN REGION INTEGRATED CARE CCS 00-4TH STREET NORTH LA CROSSE, WI 5460 La Crosse County Surveyor: Roderic Senn Lic #: 044 CHRISTIN SKOLNIK Initial Cert: 07/04/014 Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 07/01/015 06/0/016 JACKSON COUNTY HUMAN SERVICES - CCS, 40 COUNTY HWY 54 POX 457, BLACK RIVER FALLS, WI 07/01/015 06/0/016 MONROE COUNTY HUMAN SERVICES CCS, 1401 COUNTY HWY B, SPARTA, WI /01/015 06/0/016 ADDICTION MEDICAL SOLUTIONS OF WISCONSIN LLC Lic #: EAST 16 FRONTAGE RD #100 ONALASKA, WI La Crosse County Surveyor: Roderic Senn PATRICIA RUDA Initial Cert: 09/17/01 [email protected] Phone: (608) /01/015 08/1/016 Fax: (608) CSAS-NARCOTIC TREATMENT DHS /01/015 08/1/016 09/01/015 08/1/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH Lic #: TH AVENUE, SOUTH ONALASKA, WI La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/000 [email protected] Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 Lafayette County LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: N. MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/01 10/1/015 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 Langlade County 09/9/015 Page 48 of 1

49 Lincoln County ANDERSON & ASSOCIATES COUNSELING AND PSYCHOLOGIST SERVICES Lic #: EAST SECOND ST MERRILL, WI 5445 Lincoln County Surveyor: Polly Wong BREEZY BONNEVILLE Initial Cert: 04/01/004 Phone: (715) /01/015 0/1/017 Fax: (715) /01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 49 of 1

50 Manitowoc County PATHWAYS TO A BETTER LIFE 1, LLC 1111 LAX CHAPEL RD KIEL, WI 504 Manitowoc County Lic #: 060 CHRISTIANA BIES Initial Cert: 04/1/015 [email protected] Phone: (90) /1/015 0/1/016 Fax: CSAS-TRANSITIONAL RESIDENTIAL DHS /1/015 0/1/016 PATHWAYS TO A BETTER LIFE, LLC 117 LAX CHAPEL RD KIEL, WI 504 Manitowoc County Lic #: 088 CHRISTINA BIES Initial Cert: 05/15/015 [email protected] Phone: (90) /15/015 04/0/016 Fax: CSAS-TRANSITIONAL RESIDENTIAL DHS /15/015 04/0/016 MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT Lic #: S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/01 10/1/015 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 MANITOWOC COUNTY HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: S. 8TH STREET MANITOWOC, WI 541 Manitowoc County JEFF JENSWOLD Initial Cert: 0/06/007 [email protected] Phone: (90) /01/015 0/9/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 09/9/015 Page 50 of 1

51 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC 115 E. WALDO BOULEVARD MANITOWOC, WI 540 Manitowoc County Lic #: 1591 TODD EIDEN, PHD Initial Cert: 08/6/1991 Phone: (90) /01/014 10/1/016 Fax: (90) /01/014 10/1/016 11/01/014 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 111 NORTH 7TH STREET, SHEBOYGAN, WI /01/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 807 CENTER STREET, SHEBOYGAN, WI /01/014 1/1/014 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 110 LINCOLN ST, WISCONSIN RAPIDS, WI /5/016 10/1/016 09/9/015 Page 51 of 1

52 Marathon County COURAGE TO CHANGE RECOVERY 106 GALVIN ROAD ABBOTSFORD, WI Marathon County Surveyor: Polly Wong Lic #: 180 RAE ANN WICHLACZ Initial Cert: 01/07/000 Phone: (715) /01/01 10/1/015 Fax: (715) /01/01 10/1/015 11/01/01 10/1/015 1 COURAGE TO CHANGE RECOVERY, 880 E PERKINS, #10, MEDFORD, WI /01/01 10/1/015 COURAGE TO CHANGE RECOVERY, 188 N LAKE AVENUE, PO BOX, PHILLIPS, WI CHEQUAMEGON HIGH SCHOOL, 400 9TH STREET, NORTH, PARK FALLS, WI /01/01 10/1/015 10/01/014 10/1/015 ATTIC CORRECTIONAL SERVICES, INC-ACS CLINICAL SERVICES, LLC-WAUSAU Lic #: N SECOND STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong MARK ROSSANO Initial Cert: 10/01/008 [email protected] Phone: (715) /0/014 09/0/016 Fax: (715) /0/014 09/0/016 CHARIS COUNSELING, LLC 60 W. STEWART AVENUE, #10 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 464 LORI THOMPSON Initial Cert: 09/01/00 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/18/016 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 CHARIS COUNSELING, LLC, 101 W MC MILLAN STREET, #B, MARSHFIELD, WI /01/014 08/1/016 09/9/015 Page 5 of 1

53 COMPASS COUNSELING WAUSAU, LLC 50 GRANT STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 99 TRACY PETERSON Initial Cert: 0/5/011 Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU LLC, 19 SUPERIOR ST, ANTIGO, WI /01/014 1/1/014 1 COMPASS COUNSELING WAUSAU LLC, 60 E WALL STREET, EAGLE RIVER, WI /01/014 0/1/015 1 COMPASS COUNSELING WAUSAU, LLC, 1004 FIRST ST, STE, STEVENS POINT, WI /0/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 50 8TH ST S, WISCONSIN RAPIDS, WI /01/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 86 S. SUPERIOR ST., STE 109, ANTIGO, WI /0/015 0/1/016 ADAMS FRIENDSHIP ELEMENTARY, 500 N PIERCE ST, ADAMS, WI 5910 ADAMS FRIENDSHIP HIGH SCHOOL, 1109 E NORTH ST, ADAMS, WI 5910 ADAMS FRIENDSHIP MIDDLE SCHOOL, 40 N MAIN ST, ADAMS, WI /19/014 0/1/016 09/19/014 0/1/016 09/19/014 0/1/016 DIX & GILLETTE COUNSELING SERVICES, LLP 170 MERRILL AVE SUITE 401 WAUSAU, WI Marathon County Surveyor: Polly Wong Lic #: 49 MICHAEL DIX Initial Cert: 0/01/001 [email protected] Phone: (715) /01/014 01/1/016 Fax: (715) /01/014 01/1/016 0/01/014 01/1/016 ELMERGREEN ASSOCIATES, INC. 114 GRAND AVENUE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 199 DENNIS ELMERGREEN Initial Cert: 11/05/199 [email protected] Phone: (715) /01/01 10/1/015 Fax: (715) /01/01 10/1/015 11/01/01 10/1/015 ELMERGREEN ASSOCIATES, INC, 607 E ELIZABETH STREET, SHAWANO, WI /01/01 10/1/015 MILWAUKEE HEALTH SERVICES SYSTEMS DBA WAUSAU HEALTH SERVICES Lic #: W WASHINGTON STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong NANCY ELLIS Initial Cert: 01/1/00 [email protected] Phone: (715) /01/014 10/1/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-NARCOTIC TREATMENT DHS /01/014 10/1/016 1/01/014 10/1/016 1/01/014 10/1/016 09/9/015 Page 5 of 1

54 NORTH CENTRAL HEALTH CARE 1100 LAKE VIEW DRIVE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 1677 AEKTA DASSOW Initial Cert: 10/01/1975 Phone: (715) /01/015 0/8/017 Fax: (715) CSAS-AMBULATORY DETOXIFICATION DHS CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 07/0/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 ANTIGO CENTER, 15 LANGLADE ROAD, ANTIGO, WI /01/015 0/8/017 MERRILL CENTER, 607 N SALES STREET, #09, MERRILL, WI /01/015 0/8/017 TOMAHAWK OFFICE, 1 WEST WISCONSIN AVE, TOMAHAWK, WI /01/015 0/8/017 NORTH CENTRAL HEALTH CARE CCS 1100 LAKE VIEW DRIVE WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 041 ERICA HUFFMAN Initial Cert: 07/01/014 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CCS REGIONAL MODEL UNIFIED BOARD DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 15 LANGLADE ROAD, ANTIGO, WI /01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LINCOLN COUNTY, 607 NORTH SALES ST. SUITE 09, MERRILL, WI 01/01/015 1/1/016 PEACEFUL SOLUTIONS COUNSELING 741 NORTH 1ST STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 715 LEE SHIPWAY Initial Cert: 0/01/007 [email protected] Phone: (715) /01/014 0/9/016 Fax: (715) /01/014 0/9/016 0/01/014 0/9/016 1 PEACEFUL SOLUTIONS COUNSELING, 76 EAST ND STREET, MERRILL, WI /01/014 0/9/016 EDGAR MIDDLE/HIGH SCHOOL, 0 E. BIRCH STREET, EDGAR, WI /5/015 0/9/016 09/9/015 Page 54 of 1

55 THE CENTRE FOR WELL-BEING, INC. 901 N 6TH STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 1909 NOREEN SALZMAN Initial Cert: 0/17/199 [email protected] Phone: (715) /01/015 08/1/017 Fax: (888) /01/015 08/1/017 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 1415 EAGLE STREET, RHINELANDER, WI /01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 01 N CENTER AVE, MERRILL, WI /01/015 08/1/017 LAC DU FLAMBEAU ELEMENTARY SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI /01/015 08/1/017 Marinette County MARINETTE COUNTY HEALTH & HUMAN SERVICES CCS Lic #: HALL AVENUE SUITE B MARINETTE, WI 5414 Marinette County JESSICA BEAUCHAMP Initial Cert: 08/01/01 Phone: (715) /01/015 07/1/016 Fax: (715) COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 COMPREHENSIVE COMMUNITY SERVICES WITH TELEHEALTH DHS 6 08/01/015 07/1/016 08/01/015 07/1/016 MARINETTE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT/ADAPT Lic #: HALL AVENUE MARINETTE, WI 5414 Marinette County ROBERT VALENTINE Initial Cert: 01/01/198 [email protected] Phone: (715) /01/01 11/0/015 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 MARINETTE COUNTY HHSD/ADAPT, 101 JACKSON STREET, NIAGARA, WI /01/01 11/0/015 ST. JOSEPH'S HOSPITAL - HOSPITAL SISTERS -THIRD ORDER OF ST FRANCIS DBA LIBERTAS Lic #: DUNLAP SQUARE BLDG, #5 MARINETTE, WI 5414 Marinette County BARBARA CONIFF Initial Cert: 05/18/1999 [email protected] Phone: (715) /01/014 05/1/016 Fax: (715) /01/014 05/1/016 09/9/015 Page 55 of 1

56 Marquette County MARQUETTE COUNTY HUMAN SERVICES 480 UNDERWOOD AVE MONTELLO, WI 5949 Marquette County Surveyor: Hannah Whaley Lic #: 1560 TERESA FUFAHL Initial Cert: 0/01/1981 Phone: (608) /01/014 04/0/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 Menominee County MENOMINEE COUNTY HEALTH & HUMAN SERVICES DEPARTMENT Lic #: 1587 W7 WOLF RIVER ROAD KESHENA, WI 5415 Menominee County AMY ZIMMER Initial Cert: 11/01/1994 Phone: (715) /01/015 04/0/017 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 56 of 1

57 REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC Lic #: W BRADLEY ROAD BROWN DEER, WI 5 CANDICE LIPSKI Initial Cert: 09/01/009 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) /01/014 08/1/016 09/01/014 08/1/016 ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT Lic #: W SCHROEDER DRIVE BROWN DEER, WI 5 Surveyor: Merrilee Follensbee JESSICA PITRE Initial Cert: 07/1/004 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 ROGERS MEMORIAL HOSPITAL, INC 4600 WEST SCHROEDER DRIVE BROWN DEER, WI 5 Lic #: 084 JAMES KUBICEK Initial Cert: 04/8/015 Phone: (414) /8/015 0/1/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /8/015 0/1/016 04/8/015 0/1/016 04/8/015 0/1/016 04/8/015 0/1/016 AURORA HEALTH CARE METRO, INC. DBA AURORA ST. LUKE'S SOUTH SHORE Lic #: S. LAKE DRIVE CUDAHY, WI 5110 NORMAN SHANKS Initial Cert: 11/01/1989 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 09/0/016 07/09/015 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 09/9/015 Page 57 of 1

58 AURORA BEHAVIORAL HEALTH - FRANKLIN 900 W. LOOMIS ROAD, #17 FRANKLIN, WI 51 Lic #: 1650 KATHERINE CONNELLY Initial Cert: 05/0/1994 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 05/01/015 04/0/017 1 AURORA BEHAVIORAL HEALTH CENTER - MOORLAND, S68W15500 JANESVILLE RD, MUSKEGO, WI 5 05/01/015 04/0/017 AURORA BEHAVIORAL HEALTH CENTER - LAYTON, 000 E. LAYTON AVE., STE 50, SAINT FRANCIS, W AURORA BEHAVIORAL HEALTH CENTER-LAKESHORE, 611 CHICAGO AVE, SOUTH MILWAUKEE, WI 5 05/01/015 04/0/017 05/01/015 04/0/017 SHOREHAVEN BEHAVIORAL HEALTH INC 900 W BROWN DEER ROAD #00 GLENDALE, WI 509 Lic #: 186 LYNN GODEC Initial Cert: 07/01/198 [email protected] Phone: (414) /01/014 06/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH INC, 77 W CLEVELAND AVE, MILWAUKEE, WI /01/014 06/01/015 SHOREHAVEN BEHAVIORAL HEALTH INC, 470 SOUTH 76TH STREET, GREENFIELD, WI 50 07/01/014 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 607 N GRANDVIEW BLVD., # 10, WAUKESHA, WI /01/015 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 6 DURAND AVE #F, RACINE, WI /01/014 06/0/016 CEDAR CREEK FAMILY COUNSELING, INC WEST LAYTON AVE SUITE GREENFIELD, WI 58 Lic #: 1145 BUCKLEY MEADE Initial Cert: 09/15/199 [email protected] Phone: (414) /01/01 09/0/015 Fax: (414) /01/01 09/0/015 10/01/01 09/0/015 SERENITY RECOVERY CLINIC LLC 6510 W LAYTON AVE, STE 5 GREENFIELD, WI 50 Lic #: 091 JOHN LUZNICKY CSAC Initial Cert: 05/08/015 [email protected] Phone: (414) /08/015 04/0/016 Fax: (414) /08/015 04/0/016 1 SERENITY RECOVERY CLINIC LLC, 401 WEST NORTH WATER STREET #0, NEW LONDON, WI /08/015 04/0/016 09/9/015 Page 58 of 1

59 ND CENTURY 187 S 85TH STREET MILWAUKEE, WI 57 Lic #: 68 DAWN ROLLING Initial Cert: 08/0/006 [email protected] Phone: (414) /01/014 01/1/016 Fax: (414) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 01/1/016 A STRONG FOUNDATION COUNSELING SERVICES, LLC Lic #: N OAKLAND AVENUE MILWAUKEE, WI 511 NEAOKIA COLLINS Initial Cert: 11/06/01 [email protected] Phone: (414) /01/014 10/1/015 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 10/1/015 1/01/014 10/1/015 1/01/014 10/1/015 ACACIA MENTAL HEALTH CLINIC, LLC 58 W FOND DU LAC AVE MILWAUKEE, WI 516 Surveyor: Merrilee Follensbee Lic #: 1006 ABE FREUND Initial Cert: 10/01/199 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 1645 N. FARWELL ST., SUITE 0, MILWAUKEE, WI 50 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 91 S KINNICKINNIC AVENUE, MILWAUKEE, WI /01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 6040 WEST LISBON AVE STE #10, MILWAUKEE, WI /01/015 07/1/017 ACHIEVEMENT ASSOCIATES, LTD WEST BLUEMOUND RD MILWAUKEE, WI 56 Lic #: 1010 NEENA FLORSHEIM Initial Cert: 07/01/199 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) /01/015 05/1/017 06/01/015 05/1/017 09/9/015 Page 59 of 1

60 AIDS RESOURCE CENTER OF WISCONSIN 80 N. PLANKINTON AVENUE MILWAUKEE, WI 50 Lic #: 406 KEVIN ROEDER Initial Cert: 10/0/00 Phone: (414) /01/015 1/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 1/0/016 01/01/015 1/0/016 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-KENOSHA, 11-57TH STREET, KENOSHA, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-LA CROSSE, 505 KING STREET, LA CROSSE, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WISCONSIN, 6 C WEST WISCONSIN AVE, APPLETON, WI /01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI /01/015 1/0/016 1 AIDS RESOURCE ENTER OF WI-EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI /01/015 1/0/016 1 ARCW, 16 W. GRAND AVENUE, BELOIT, WI /01/015 1/0/016 1 ARCW, 600 WILLIAMS STREET, MADISON, WI 570 0/01/015 1/0/016 AIDS RESOURCE CENTER OF WI-GREEN BAY, 445 S ADAMS STREET, GREEN BAY, WI /01/015 1/0/016 AMRI COUNSELING SERVICES, LLC 4001 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 875 LAKEIA JONES Initial Cert: 08/01/009 [email protected] Phone: (414) /01/014 07/1/016 Fax: (866) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 1 AMRI COUNSELING SERVICES, 1 6RD ST, KENOSHA, WI /9/014 07/1/016 ARC MILWAUKEE WOMEN'S PROGRAM 10 W MADISON STREET MILWAUKEE, WI 504 Lic #: 069 ROBIN RYAN Initial Cert: 1/11/014 [email protected] Phone: (414) /11/014 11/0/015 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS /11/014 11/0/015 09/9/015 Page 60 of 1

61 AURORA BEHAVIORAL HEALTH - NORTH SHORE Lic #: N. PORT WASHINGTON, #0 MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 08/01/1985 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) /01/014 07/1/016 08/01/014 07/1/016 1 AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER STREET, HARTFORD, WI /01/014 07/1/016 AURORA BEHAVIORAL HEALTH - GRAFTON, 975 N. PORT WASHINGTON RD, GRAFTON, WI 504 AURORA BEHAVIORAL HEALTH - WEST BEND, 05 VALLEY AVENUE, WEST BEND, WI /01/014 07/1/016 08/01/014 07/1/016 AURORA BEHAVIORAL HEALTH CENTER - SINAI 100 N 1TH ST 4TH FLOOR MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 189 KATE CONNELLY Initial Cert: 10/01/1987 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) /01/014 1/1/015 01/01/014 1/1/015 BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM Lic #: W WELLS STREET, #700 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee MEAGAN WINN Initial Cert: 01/15/00 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) /01/014 1/1/015 CAREER YOUTH DEVELOPMENT, INC. 60 N. MARTIN LUTHER KING DR. MILWAUKEE, WI 51 Lic #: 117 STERLON WHITE Initial Cert: 0/15/199 [email protected] Phone: (414) /01/015 05/1/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 05/1/016 06/01/015 05/1/016 06/01/015 05/1/016 09/9/015 Page 61 of 1

62 CENTER FOR QUALITY COMMUNITY LIFE, INC. (CQCL) Lic #: W VILLARD AVENUE, #00 MILWAUKEE, WI 518 KATHY CARTER Initial Cert: 08/01/01 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 CITY TRANSFORMATION CLINIC NORTH 144 NORTH FARWELL AVENUE, SUITE 00 MILWAUKEE, WI 50 Lic #: 918 THERESA ANTHONY Initial Cert: 09/06/010 theresa.anthony@citytransformation Phone: (414) /01/01 08/1/015 Fax: (866) CSAS-DAY TREATMENT DHS /01/01 08/1/015 09/01/01 08/1/015 COLUMBIA ST. MARY'S BEHAVIORAL MEDICINE - MILWAUKEE Lic #: 1870 N LAKE DRIVE, 7TH FLOOR MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM FRY Initial Cert: 06/01/1981 [email protected] Phone: (414) /01/014 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE CAMPUS Lic #: N LAKE DRIVE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM L. FRY Initial Cert: 07/01/015 [email protected] Phone: (414) /01/015 06/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 06/0/016 07/01/015 06/0/016 09/9/015 Page 6 of 1

63 EBB TIDE THERAPY 81 N 4TH STREET RM 144 MILWAUKEE, WI 51 Lic #: 956 SHANNON O'BRIEN Initial Cert: 0/01/01 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) /01/015 01/1/017 0/01/015 01/1/017 EMPATHETIC COUNSELING SERVICES INC W BURLEIGH ST MILWAUKEE, WI 510 Lic #: 95 TANYA BROUGHTON LEWIS Initial Cert: 1/01/011 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) -5 CSAS-DAY TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1 EMPATHETIC COUNSELING SERVICES SOUTH, 551 WEST HISTORIC MITCHELL ST, MILWAUKEE, WI 5 1/01/014 11/0/016 FOKUS FAMILY SERVICES 81 N. 4TH STREET, #19 MILWAUKEE, WI 51 Lic #: 47 ELZORA COLLINS Initial Cert: 0/01/014 [email protected] Phone: (414) /01/014 0/9/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 0/8/015 04/01/014 0/9/016 04/01/014 0/9/016 FOREVER FREE SUBSTANCE ABUSE & MENTAL HEALTH TREATMENT CENTER Lic #: S LAYTON BLVD MILWAUKEE, WI 515 DR. CHARLES GREEN Initial Cert: 11/1/014 [email protected] Phone: (414) /1/014 10/1/015 Fax: CSAS-DAY TREATMENT DHS /1/014 10/1/015 11/1/014 10/1/015 09/9/015 Page 6 of 1

64 GATEWAY TO CHANGE 19 W. CAPITOL DRIVE MILWAUKEE, WI 506 Lic #: 479 GLENDA HAMPTON Initial Cert: 10/9/00 Phone: (414) /01/014 11/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GENESIS BEHAVIORAL SERVICES, INC. MEN'S AODA RESIDENTIAL Lic #: N. 50TH STREET MILWAUKEE, WI 510 GINA SINGLETERY Initial Cert: 07/15/199 Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 07/1/016 GENESIS MILWAUKEE OUTPATIENT CLINIC 0 W WELLS STREET, #1 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 177 GINA SINGLETERY Initial Cert: 1/01/1987 [email protected] Phone: (414) /01/014 11/0/015 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 11/0/015 1/01/014 11/0/015 1/01/014 11/0/015 GENESIS WOMEN'S RESIDENTIAL PROGRAM 547 W VILLARD STREET MILWAUKEE, WI 518 Surveyor: Merrilee Follensbee Lic #: 0 GINA SINGLETERY Initial Cert: 05/15/1998 [email protected] Phone: (414) /01/015 05/1/017 Fax: (414) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 05/1/017 09/9/015 Page 64 of 1

65 GRO FAMILY SERVICES 6400 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 80 GREGORY OWENS Initial Cert: 08/8/008 Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 GRO FAMILY SERVICES II, 55 WEST CAPITOL DRIVE, MILWAUKEE, WI /01/015 07/1/017 GUEST HOUSE COUNSELING CLINIC 116 N. 1TH STREET MILWAUKEE, WI 505 Surveyor: Merrilee Follensbee Lic #: 101 KRISTEN VAREKA Initial Cert: 07/15/199 Phone: (414) /01/015 07/1/017 Fax: (414) /01/015 07/1/017 08/01/015 07/1/017 HORIZON HEALTHCARE INC 4650 S HOWELL AVENUE MILWAUKEE, WI 507 Lic #: 174 EMILY HILL Initial Cert: 11/01/1999 [email protected] Phone: (414) /1/014 10/1/015 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/1/014 10/1/015 01/1/014 10/1/015 01/1/014 10/1/015 01/1/014 10/1/015 HORIZON HEALTHCARE, INC, 5408 W BURLEIGH ST, MILWAUKEE, WI /1/014 10/1/015 HORIZON HEALTHCARE, INC, 6 WEST WISCONSIN AVE #1810, MILWAUKEE, WI 50 01/1/014 09/0/014 INNER CITY BEHAVIORAL SERVICES, LLC 7514 W APPLETON AVENUE SUITE 4 MILWAUKEE, WI 516 Lic #: 087 BARBARA TRIPP Initial Cert: 04/01/015 [email protected] Phone: (414) /01/015 0/1/016 Fax: (414) /01/015 0/1/016 04/01/015 0/1/016 09/9/015 Page 65 of 1

66 KIDS IN TRANSITION, INC 81 NORTH 4TH STREET STE #08 MILWAUKEE, WI 51 Lic #: 607 CLEON SUGGS Initial Cert: 10/9/01 Phone: (414) /17/015 06/0/016 Fax: (414) /17/015 06/0/016 LA CAUSA, INC. 11 S 70TH ST #115A MILWAUKEE, WI 514 Surveyor: Merrilee Follensbee Lic #: 67 CHYRA TROST Initial Cert: 04//00 [email protected] Phone: (414) /01/015 04/0/017 Fax: (414) /01/015 04/0/017 05/01/015 04/0/017 LIFE CHANGING MINISTRIES INC. 677 NORTH TEUTONIA AVENUE MILWAUKEE, WI 509 Lic #: 045 ARTHUR KENNEDY Initial Cert: 07/16/014 [email protected] Phone: (414) /01/015 06/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 06/0/016 07/01/015 06/0/016 LOCKETT ENTERPRISES, LLC BEHAVIORAL HEALTH SERVICES Lic #: 09 0 W WELLS STREET, SUITE 14 MILWAUKEE, WI 50 OTIS LOCKETT JR. Initial Cert: 07/9/014 [email protected] Phone: (414) /01/015 07/1/016 Fax: (414) -07 CSAS-DAY TREATMENT DHS /01/015 07/1/016 08/01/015 07/1/016 08/01/015 07/1/016 09/9/015 Page 66 of 1

67 M & S CLINICAL SERVICES, INC. 81 NORTH 4TH ST #516 MILWAUKEE, WI 51 Lic #: 1546 MARK FOSSIE Initial Cert: 1/04/1996 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) /01/015 0/8/017 04/01/015 0/8/017 MATT TALBOT RECOVERY CENTER 61 W. NORTH AVENUE MILWAUKEE, WI 505 Lic #: 157 ANTONEO DESHAZOR Initial Cert: 0/07/1997 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 0/8/017 MATT TALBOT RECOVERY SERVICES INC (FIRST STEP COMMUNITY RECOVERY CTR) Lic #: N ND STREET MILWAUKEE, WI 510 DARREN MATAVKA Initial Cert: 0/05/015 [email protected] Phone: (414) /05/015 01/1/016 Fax: (414) CSAS-AMBULATORY DETOXIFICATION DHS CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS /05/015 01/1/016 0/05/015 01/1/016 0/05/015 01/1/016 MATTERS OF THE SPIRIT, LLC 6815 WEST CAPITOL DRIVE, SUITE 11 MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 06 PASTOR TINA SANFORD Initial Cert: 01/01/015 [email protected] Phone: (414) /01/015 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 09/9/015 Page 67 of 1

68 MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA Lic #: N MAYFAIR ROAD MILWAUKEE, WI 56 JEFFREY G MILLER Initial Cert: 07/01/1996 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 0/01/015 01/1/017 MD THERAPY 6815 W CAPITOL DRIVE, #08 MILWAUKEE, WI 516 Lic #: 5 THOMAS (MIKE) DALE Initial Cert: 05/05/000 [email protected] Phone: (414) /01/015 05/1/016 Fax: (414) /01/015 05/1/016 01/01/015 05/1/016 META HOUSE, INC (SHOREWOOD CAMPUS) AKA META III Lic #: N. MARYLAND AVENUE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee CHRISTINE ULLSTRUP Initial Cert: 0/01/1995 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 01/1/017 0/01/015 01/1/017 META HOUSE, INC (SOUTH CAMPUS) AKA RIVERWEST Lic #: N. BREMEN STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee CHRISTINE ULLSTRUP Initial Cert: 05/0/1998 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 01/1/017 0/01/015 01/1/017 09/9/015 Page 68 of 1

69 META HOUSE, INC. 65 N WEIL STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee Lic #: 17 CHRISTINE ULLSTRUP Initial Cert: 11/4/1999 [email protected] Phone: (414) /01/01 11/0/015 Fax: (414) CSAS-DAY TREATMENT DHS /01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 META HOUSE, INC. (NORTH CAMPUS) 66 N. BREMEN STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee Lic #: 160 CHRISTINE ULLSTRUP Initial Cert: 0/01/1995 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 07/1/017 08/01/015 07/1/017 MILWAUKEE CENTER FOR INDEPENDENCE DBA TLS BEHAVIORAL HEALTH Lic #: S. 70TH STREET MILWAUKEE, WI 514 TIM MCGUIRE Initial Cert: 09/01/1985 [email protected] Phone: (414) /01/015 05/1/017 Fax: (414) /01/015 05/1/017 06/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 057 S 14TH STREET, MILWAUKEE, WI /01/015 05/1/017 1 CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI /01/015 05/1/017 1 MILWAUKEE CENTER FOR INDEPENDENCE, 00 W WELLS STREET, MILWAUKEE, WI 5 06/01/015 05/1/017 1 NEXDAY, SOUTH HOWELL AVE, MILWAUKEE, WI /01/015 05/1/017 1 TRANSITIONAL LIVING SERVICES INC, 710 DOUGLAS AVENUE, RACINE, WI /01/015 05/1/017 1 WATER TOWER VIEW, 98 S PRAIRIE HILL LANE, GREENFIELD, WI 58 06/01/015 05/1/017 09/9/015 Page 69 of 1

70 MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: WEST WATERTOWN PLANK ROAD MILWAUKEE, WI 56 AMY LORENZ Initial Cert: 09/01/014 Phone: (414) /01/015 08/1/016 Fax: CCS REGIONAL MODEL POPULATION-BASED DHS 6 1 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, W LISBON AVENUE, MILWAUKEE, WI 1 BELL THERAPY, INC, 4065 N 5TH STREET, MILWAUKEE, WI JUSTICE POINT, 05 W HIGHLAND AVE #01, MILWAUKEE, WI 5 1 LA CAUSA, INC SOCIAL SERVICES, 804 W GREENFIELD AVE, MILWAUKEE, WI 56 1 MCFI DBA TLS BEHAVIORAL HEALTH, 1040 S 70TH STREET, MILWAUKEE, WI OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI ST CHARLES YOUTH & FAMILY SERVICES, INC, 4757 N 76TH STREET, MILWAUKEE, WI THE GUEST HOUSE OF MILWAUKEE, 116 N 1TH STREET, MILWAUKEE, WI WISCONSIN COMMUNITY SERVICES, 7 W WISCONSIN AVE. SUITE 00, MILWAUKEE, WI /01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/018 08/1/016 MILWAUKEE HEALTH SERVICE SYSTEMS DBA RIVER'S SHORE CLINIC Lic #: N RICHARDS STREET MILWAUKEE, WI 51 KIVAUGHN SHELTON Initial Cert: 11/01/1986 [email protected] Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-NARCOTIC TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 MILWAUKEE HEALTH SERVICE SYSTEMS II 4800 S 10TH STREET #1 MILWAUKEE, WI 51 Lic #: 1644 LISA CRANE Initial Cert: 10/01/1995 [email protected] Phone: (414) /01/015 04/0/016 Fax: (414) CSAS-NARCOTIC TREATMENT DHS /01/015 04/0/016 05/01/015 04/0/016 MULTI-CULTURAL COUNSELING SERVICES II INC, DBA RENEW COUNSELING SERVICES Lic #: W CAPITOL DR SUITE #105 MILWAUKEE, WI 504 WAYNE CROATT Initial Cert: 1/01/01 [email protected] Phone: (414) /01/014 11/0/016 Fax: (414) /01/014 11/0/016 1/01/014 11/0/016 09/9/015 Page 70 of 1

71 MWCCA BEHAVIORAL HEALTH CLINIC 78 NORTH JAMES LOVELL ST MILWAUKEE, WI 5 Lic #: 1794 LATRICE BUCK HOGAN Initial Cert: 0/01/1988 [email protected] Phone: (414) /01/014 06/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 NEW CHOICES, LLC 565 N MARTIN LUTHER KING DR MILWAUKEE, WI 51 Lic #: 90 LEOLA WILLIAMS Initial Cert: 10/14/010 [email protected] Phone: (414) /01/015 09/0/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY, INC. Lic #: N FARWELL, SUITE 00 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THERESA ANTHONY Initial Cert: 1/01/014 [email protected] Phone: (414) /01/014 11/0/015 Fax: (866) CSAS-DAY TREATMENT DHS /01/014 11/0/015 1/01/014 11/0/015 1/01/014 11/0/015 OMNI ENRICHMENT, INC. 00 W. VLIET STREET MILWAUKEE, WI 508 Lic #: 41 BARBARA TRIPP Initial Cert: 0/01/00 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) /01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 71 of 1

72 OUTREACH COMMUNITY HEALTH CENTERS INC 10 W CAPITOL DRIVE MILWAUKEE, WI 51 Lic #: 46 ANGELA SANDERS Initial Cert: 08/01/000 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) /01/014 07/1/016 08/01/014 07/1/016 OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI /01/014 07/1/016 PARADIGM ENRICHMENT SERVICES, INC WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 990 FREDERICK G. JACKSON, II Initial Cert: 0/5/01 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 0/8/017 0/01/015 0/8/017 0/01/015 0/8/017 POSITIVE OUTLOOK CLINICAL SERVICES LLC 445 NORTH 60TH STREET MILWAUKEE, WI 518 Lic #: 796 PAMELA HANSEN Initial Cert: 08/01/008 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP Lic #: WEST CAPITOL DRIVE STE LL MILWAUKEE, WI 516 CARLA WILLIAMS Initial Cert: 01/16/01 [email protected] Phone: (414) /01/015 0/1/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 0/1/016 04/01/015 0/1/016 04/01/015 0/1/016 09/9/015 Page 7 of 1

73 RAVENSWOOD CLINIC 66 N. PROSPECT AVENUE, #6 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 118 ANTHONY F. WERTH, JR. Initial Cert: 06//1999 Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 RENEW COUNSELING SERVICES 15 W. MITCHELL STREET, # MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 179 WAYNE CROATT Initial Cert: 04/01/1985 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) /01/015 08/1/017 09/01/015 08/1/017 ROOTS COUNSELING SERVICES 186 N FARWELL AVE MILWAUKEE, WI 511 Lic #: 08 JEREMY A. JAEGER Initial Cert: 07/16/014 [email protected] Phone: (414) /01/015 06/0/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC Lic #: W FLORIST AVENUE #15 MILWAUKEE, WI 509 Surveyor: Merrilee Follensbee SEBASTIAN SSEMPIJJA Initial Cert: 01/14/004 [email protected] Phone: (414) /01/015 1/1/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 1 SEBASTIAN FAMILY PSYCHOLOGY, 745 W LAYTON AVE, STE 0, MILWAUKEE, WI 51 01/01/015 1/1/016 AUDUBON TECHNOLOGY & COMMUNICATION CENTER, 00 SOUTH 9TH STREET, MILWAUKEE, WI OLIVER WENDALL HOLMES SCHOOL, 46 NORTH BUFFUM STREET, MILWAUKEE, WI 51 01/01/015 1/1/016 01/01/015 1/1/016 09/9/015 Page 7 of 1

74 SHECAR SUBSTANCE ABUSE/MENTAL HEALTH OUTPATIENT TREATMENT CENTER, LLC Lic #: N 4TH STREET, #08 MILWAUKEE, WI 51 SHEILA R RAMOS Initial Cert: 06/7/011 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM Lic #: N. RICHARDS STREET MILWAUKEE, WI 51 ELLA DUNBAR Initial Cert: 04/9/00 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) /01/014 04/0/016 05/01/014 04/0/016 ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER Lic #: N. 76TH STREET MILWAUKEE, WI 518 GLYNIS UNDERWOOD Initial Cert: 01/01/1991 [email protected] Phone: (414) /01/015 01/1/017 Fax: (414) /01/015 01/1/017 0/01/015 01/1/017 1 ST CHARLES - FAMILY DEVELOP CTR, 151 S 84TH STREET, MILWAUKEE, WI 514 0/01/015 01/1/017 ST. LUKE'S MEDICAL CENTER OUTPATIENT BEHAVIORAL HEALTH CLINIC Lic #: W OKLAHOMA AVENUE MILWAUKEE, WI 515 KATE CONNELLY Initial Cert: 08/0/006 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) /01/015 08/1/017 09/01/015 08/1/017 09/9/015 Page 74 of 1

75 ST. ROSE YOUTH & FAMILY CENTER 801 N. 88TH STREET MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 1876 JESSICA WALDRON Initial Cert: 07/05/1985 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) /01/014 08/1/016 09/01/014 08/1/016 1 LAD LAKE, INC. DOUSMAN, W50 - S1401 WATERVILLE ROAD, DOUSMAN, WI /8/015 08/1/016 THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS Lic #: W WALNUT STREET, SUITE -R MILWAUKEE, WI 51 TODD CAMPBELL Initial Cert: 08/19/010 toddcampbell@thebridgehealthclinic Phone: (414) /01/015 07/1/017 Fax: (414) CSAS-DAY TREATMENT DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC - CAPITOL DRIVE, 5 W. CAPITOL DRIVE, #7, MILWAUKEE, WI 5 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC - CAPITOL DRIVE, 6751 W. GREENFIELD AVE., MILWAUKEE, WI 5 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC, INC. - APPLETON AV, 75 APPLETON AVE, MILWAUKEE, WI 51 08/01/015 07/1/017 1 THE BRIDGE HEALTH CLINICS & RC, INC. - BELOIT RD, 9401 BELOIT RD, SUITE 105, MILWAUKEE, WI 5 08/01/015 07/1/017 THE POWER OF CHANGE INC BEHAVIORAL SERVICES Lic #: N 4TH STREET SUITE 145 MILWAUKEE, WI 51 RHONDA ARMON-BENT Initial Cert: 07/01/011 [email protected] Phone: (414) /01/015 1/1/016 Fax: (414) /01/015 1/1/016 01/01/015 1/1/016 UNITED COMMUNITY CENTER 1100 S 6TH STREET, RD FLOOR MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 1657 JUAN A. RUIZ Initial Cert: 05/01/1980 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 09/9/015 Page 75 of 1

76 UNITED COMMUNITY CENTER 604 W SCOTT STREET MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 881 JUAN A. RUIZ Initial Cert: 08/1/009 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 07/1/016 08/01/014 07/1/016 UNITED COMMUNITY CENTER LATINAS UNIDAS 11 SOUTH 6TH STREET MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 51 JUAN A. RUIZ Initial Cert: 0/17/014 [email protected] Phone: (414) /01/015 0/1/017 Fax: (414) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 0/1/017 04/01/015 0/1/017 WCS-MILWAUKEE COUNTY DAY REPORTING CENTER Lic #: S 9TH ST, BASEMENT MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee JOY FITZSIMONS Initial Cert: 10/01/014 [email protected] Phone: (414) /01/015 09/0/017 Fax: (414) /01/015 09/0/017 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. FRANCIS HOSPITAL Lic #: S 16TH STREET #00 MILWAUKEE, WI 515 BARBARA JONES Initial Cert: 10/7/004 [email protected] Phone: (414) /01/01 10/1/015 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 1 WHEATON FRAN BEHAV HEALTH - ST. FRANCIS, 5650 N GREEN BAY AVENUE, #00, BROWN DEER, W 11/01/01 06/0/015 1 WHEATON FRANCISAN BEHAVIORAL HEALTH - FRANKLIN, 9969 S 7TH STREET, FRANKLIN, WI 51 10/09/014 10/1/015 09/9/015 Page 76 of 1

77 WHEATON FRANCISCAN BEHAVIORAL HEALTH - ST. JOSEPH REGIONAL MEDICAL CENTER Lic #: W CHAMBERS ST #P10 MILWAUKEE, WI 510 CAROL HESS Initial Cert: 10/7/004 [email protected] Phone: (414) /01/01 10/1/015 Fax: (414) /01/01 10/1/015 11/01/01 10/1/015 1 WHEATON FRANCISCAN MEDICAL GROUP, 5650 N. GREEN BAY AVENUE, SUITE 00, GLENDALE, WI 5 07/01/015 10/1/015 WILLOWGLEN ACADEMY OUTPATIENT CLINIC 4065 NORTH 5TH STREET STE # N100 MILWAUKEE, WI 516 Lic #: 004 SHANNA MALONEY Initial Cert: 08/01/199 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) /01/014 07/1/016 08/01/014 07/1/016 1 WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI /01/014 07/1/016 WILLOWGLEN ACADEMY - DAY ONE EAST, 6414 W. FOND DU LAC AVE, MILWAUKEE, WI 518 WILLOWGLEN ACADEMY, 5555 NORTH 51ST BLVD, MILWAUKEE, WI 518 WILLOWGLEN ACADEMY-HOWARD JANSEN LEARNING, W16 COUNTY HWY FF, SHEBOYGAN, WI 5 WILLOWGLEN ACADEMY - ARROWHEAD UNION HS, 700 NORTH AVE, HARTLAND, WI /01/014 07/1/016 08/01/014 07/1/016 08/01/014 01/01/015 08/01/014 07/1/016 WISCONSIN COMMUNITY SERVICES UNLIMITED POTENTIALS Lic #: W. WELLS STREET, #500 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THOMAS CARROLL Initial Cert: 06/01/1986 [email protected] Phone: (414) /01/014 09/0/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 UNLIMITED POTENTIAL MILW CNTY DAY REPORT CNTR, 167 SOUTH 9TH STREET, MILWAUKEE, WI 5 10/01/014 10/01/014 WORD OF HOPE MINISTRIES ATODA PROGRAM 677 N 40TH STREET MILWAUKEE, WI 510 Lic #: 509 LEONDIS FULLER Initial Cert: 0/01/004 [email protected] Phone: (414) /01/014 0/9/016 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 09/9/015 Page 77 of 1

78 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C. Lic #: W LISBON AVENUE, #1 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee KAREN DREXLER Initial Cert: 11/0/1997 [email protected] Phone: (414) /01/01 11/0/015 Fax: (414) /01/01 11/0/015 1/01/01 11/0/015 1 ALTERNATIVES IN PSYCH CONSULT, 5757 WEST OKLAHOMA AVE, MILWAUKEE, WI 519 1/01/01 11/0/015 APPLIED THERAPIES AND WELLNESS CENTER SC Lic #: N MAYFAIR ROAD, #05 WAUWATOSA, WI 56 Surveyor: Merrilee Follensbee TRISHA WOLLIN Initial Cert: 05/0/007 twollin@appliedtherapiesandwellnes Phone: (414) /01/014 05/1/016 Fax: (414) /01/014 05/1/015 06/01/014 05/1/016 AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA Lic #: DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 0/1/004 [email protected] Phone: (414) /01/015 0/8/017 Fax: (414) /01/015 0/8/017 0/01/015 0/8/017 AURORA PSYCHIATRIC HOSPITAL INC 10 DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee Lic #: 1647 JAMIE LEWISTON Initial Cert: 09/01/1979 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-TRANSITIONAL RESIDENTIAL DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 09/9/015 Page 78 of 1

79 LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN Lic #: N. MAYFAIR ROAD WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee CHUCK MESECK Initial Cert: 0/01/1978 [email protected] Phone: (414) /01/014 0/1/016 Fax: (414) /01/014 0/1/016 04/01/014 0/1/016 1 LCFS-ST JOHN LUTHERAN CHURCH, 4850 S LAKE DRIVE, CUDAHY, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 18 S. PARK AVENUE, NEENAH, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 1614 S. RD STREET, SHEBOYGAN, WI /01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 10 S. ONEIDA STREET, GREEN BAY, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 60 VINCENT ST, FOND DU LAC, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 8 RARITAN, FITCHBURG, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 940 MINERAL POINT RD, JANESVILLE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 00 BROADWAY DRIVE, SUN PRAIRIE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4 S. ANDREWS STREET, SHAWANO, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 45 NORTH PINE ST, REEDSBURG, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 701 WASHINGTON ST, GRAFTON, WI /01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 70 JACKSON AVENUE, OMRO, WI /01/015 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG STREET, PORTAGE, WI /01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E51 CHURCH ROAD, ALGOMA, WI /01/014 0/1/016 WEST GROVE CLINIC 1001 WEST CAPITOL DRIVE #101 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee Lic #: 18 TRACI MARETT Initial Cert: 06//001 [email protected] Phone: (414) /01/014 06/0/016 Fax: (414) /01/014 06/0/016 07/01/014 06/0/016 WEST GROVE CLINIC LLC, 1111 W NORTH AVENUE, #0, WAUWATOSA, WI 56 07/01/014 1/19/014 WEST GROVE CLINIC LLC, 710 W. WELLS ST., WAUWATOSA, WI 51 04/0/015 06/0/016 WEST GROVE CLINIC, 5 N. BROOKFIELD RD. #4, BROOKFIELD, WI /19/014 04/19/015 IMPACT, ALCOHOL AND OTHER DRUG ABUSE SERVICE, INC Lic #: W WASHINGTON STREET, #5 WEST ALLIS, WI 514 PATRICIA GUTIERREZ Initial Cert: 08/09/007 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-INTERVENTION DHS /01/014 07/1/016 1 IMPACT, ALCOHOL & OTHER DRUG ABUSE SERVICE, 970 NORTH OAKLAND AVE, SHOREWOOD, WI 08/01/014 07/1/016 09/9/015 Page 79 of 1

80 ROGERS MEMORIAL HOSPITAL 448 SOUTH 10ND ST RM #00 WEST ALLIS, WI 57 Lic #: 0 KEITH MOREHOUSE Initial Cert: 05/01/014 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREAT/CHILDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS /01/014 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 08/17/015 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 08/17/015 04/0/016 ROGERS MEMORIAL HOSPITAL - MILWAUKEE W. LINCOLN AVENUE WEST ALLIS, WI 57 Surveyor: Merrilee Follensbee Lic #: 14 CATHERINE HENRICKS Initial Cert: 05/01/000 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 QAM - QUALITY ADDICTION MANAGEMENT 1610 MILLER PARKWAY WEST MILWAUKEE, WI 514 Surveyor: Merrilee Follensbee Lic #: 6 CHARLES SCHRAUTH Initial Cert: 06/19/000 [email protected] Phone: (414) /01/014 08/1/016 Fax: (414) CSAS-NARCOTIC TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 09/9/015 Page 80 of 1

81 Monroe County SCENIC BLUFFS COMMUNITY HEALTH CENTERS Lic #: FRONT STREET CASHTON, WI Monroe County Surveyor: Roderic Senn JESSICA MLSNA Initial Cert: 07/8/008 Phone: (608) /01/014 06/0/016 Fax: (608) /01/014 06/0/016 07/01/014 06/0/016 MONROE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: HWY B, COMM SVS CTR A-19 SPARTA, WI Monroe County Surveyor: Roderic Senn TRACY THORSEN Initial Cert: 10/01/1975 Phone: (608) /01/014 11/0/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 Oconto County OCONTO COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: PARK AVENUE OCONTO, WI 5415 Oconto County BRUCE RETZLAFF Initial Cert: 04/01/1979 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 1 NEW VIEW INDUSTRIES, 164 W PARK STREET, GILLETT, WI /01/014 08/1/016 09/9/015 Page 81 of 1

82 Oneida County CORNERSTONE PSYCHOLOGICAL ASSOCIATES, LLC Lic #: S ONEIDA AVE SUITE 101 RHINELANDER, WI Oneida County Surveyor: Polly Wong THOMAS F. MCGUIRE, LPC Initial Cert: 08/14/01 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) /01/015 09/0/017 10/01/015 09/0/017 KOINONIA 1991 WINNEBAGO STREET RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 1469 BRUCE DECORAH Initial Cert: 10/01/1986 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 09/9/015 Page 8 of 1

83 OPTIONS COUNSELING SERVICES, LLC 158 SOUTH ANDERSON STREET, SUITE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 74 BRUCE DECORAH Initial Cert: 04/17/007 Phone: (715) /01/014 0/1/016 Fax: (715) /01/014 0/1/016 05/01/014 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 7 EAST WALL STREET, EAGLE RIVER, WI /01/014 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 944 COUNTY RD J, PO BOX 7, MINOCQUA, WI /01/014 0/1/016 OPTIONS COUNSELING SERVICES LLC, 158 SOUTH ANDERSON, SUITE, RHINELANDER, WI OPTIONS COUNSELING SERVICES LLC, 181 N STEVENS STREET, RHINELANDER, WI OPTIONS COUNSELING SERVICES LLC, 1991 WINNEBAGO STREET, RHINELANDER, WI ANTIGO HIGH SCHOOL, 1900 TENTH AVENUE, ANTIGO, WI ANTIGO MIDDLE SCHOOL, 815 SEVENTH AVENUE, ANTIGO, WI ARBOR VITAE-WOODRUFF ELEMENTARY SCHOOL, OLD STATE HWY 51 NORTH, ARBOR VITAE, CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI CRANDON ELEMENTARY/ MIDDLE/HIGH SCHOOL, 9750 US HWY 8 WEST, CRANDON, WI 5450 CRESCENT ELEMENTARY, 19 BOYCE DRIVE, RHINELANDER, WI CRESTWOOD ELEMENTARY SCHOOL, W8464 CH AA, ANTIGO, WI EAGLE RIVER ELEMENTARY SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 EAST ELEMENTARY SCHOOL, 0 SEVENTH AVENUE, ANTIGO, WI JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI LAKELAND UNION HIGH SCHOOL DISTRICT, 957 STATE HIGHWAY 70, MINOCQUA, WI LAND O' LAKES ELEMENTARY, 6485 TOWN HALL ROAD, LAND O LAKES, WI MATTOON ELEMENTARY SCHOOL, 507 STONE AVENUE, MATTOON, WI NORTH ELEMENTARY SCHOOL, 506 GRAHAM AVENUE, ANTIGO, WI NORTHLAND PINES HIGH SCHOOL, 1800 PLEASURE ISLAND ROAD, EAGLE RIVER, WI 5451 NORTHLAND PINES MIDDLE SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 NORTHWOODS COMM. SECONDARY CHARTER SCHOOL, 665 COOLIDGE AVENUE, RHINELANDER, W NORTHWOODS COMMUNITY ELEMENTARY CHARTER SCHOOL, 9086 COUNTY HWY K, HARSHAW, WI PELICAN ELEMENTARY, 50 V HICKEY ROAD, RHINELANDER, WI PLEASANT VIEW ELEMENTARY SCHOOL, W11141 CTY RD HH, ANTIGO, WI RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI SOAR CHARTER SCHOOL, 6485 TOWN HALL RD, LAND O LAKES, WI SPRING VALLEY ELEMENTARY, N4754 CTH BB, ANTIGO, WI ST GERMAIN ELEMENTARY SCHOOL, 84 HWY 70 WEST, SAINT GERMAIN, WI SUGAR CAMP ELEMENTARY, 4066 CAMP FOUR RD., RHINELANDER, WI THREE LAKES ELM/JUNIOR & SENIOR HIGH SCHOOL, 690 WEST SCHOOL ST, THREE LAKES, WI 545 WEST ELEMENTARY, 1 SEVENTH AVENUE, ANTIGO, WI /01/014 0/8/015 05/01/014 08/1/014 0/01/015 0/1/016 09/01/015 0/1/016 09/01/015 0/1/016 08/9/014 0/1/016 08/9/014 0/1/016 05/01/014 0/1/016 08/9/014 0/1/016 09/01/015 0/1/016 05/01/014 0/1/016 09/01/015 0/1/016 08/9/014 0/1/016 10/01/014 0/1/016 05/01/014 0/1/016 09/01/015 0/1/016 09/01/015 0/1/016 05/01/014 0/1/016 05/01/014 0/1/016 08/9/014 0/1/016 08/9/014 0/1/016 08/9/014 0/1/016 09/01/015 0/1/016 08/9/014 0/1/016 05/01/014 0/1/016 09/01/015 0/1/016 05/01/014 0/1/016 08/9/014 0/1/016 08/9/014 0/1/016 09/01/015 0/1/016 09/9/015 Page 8 of 1

84 ST. MARY'S HOSPITAL MINISTRY KOLLER BEHAVIORAL HEALTH Lic #: KABEL AVENUE RHINELANDER, WI Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 06/01/1985 Phone: (715) /01/014 05/1/016 Fax: (715) /01/014 05/1/016 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI /01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 90 E WALL STREET, EAGLE RIVER, WI /01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI /01/014 05/1/016 ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 11 ELM STREET, WOODRUFF, WI /01/014 05/1/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 147 DONNA SHIMECK Initial Cert: 09/01/1980 [email protected] Phone: (715) /01/015 09/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 10/01/015 09/0/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 04 DONNA SHIMECK Initial Cert: 06/7/014 Phone: (715) /01/015 06/0/017 Fax: (715) CCS REGIONAL MODEL UNIFIED BOARD DHS 6 CCS REGIONAL MODEL UNIFIED BOARD W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 TRANSITIONS CENTER, LLC N PELHAM STREET RHINELANDER, WI Oneida County Surveyor: Polly Wong Lic #: 64 RICHARD MARTIN Initial Cert: 0/01/006 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) /01/015 01/1/017 0/01/015 01/1/017 09/9/015 Page 84 of 1

85 Outagamie County ACS CLINICAL SERVICES 70 W WASHINGTON STREET APPLETON, WI 5491 Outagamie County Lic #: 608 AMANDA SWAW-WYER Initial Cert: 09/01/005 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) /01/014 08/1/016 ACS CLINICAL SERVICES - MANITOWOC, E WALDO BLVD, MANITOWOC, WI /01/014 08/1/016 ACS CLINICAL SERVICES - SHEBOYGAN, 151 SOUTH 1TH ST, SHEBOYGAN, WI /01/014 08/1/016 CASA CLARE, A DIVISION OF MOORING PROGRAMS, INC. Lic #: S GLENRIDGE COURT APPLETON, WI Outagamie County JAMIE LEOHNIS Initial Cert: 0/1/1996 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 85 of 1

86 CATALPA HEALTH, INC. 444 NORTH WESTHILL BLVD APPLETON, WI Outagamie County Lic #: 984 GREG BLUME Initial Cert: 11/01/01 Phone: (90) /01/01 10/1/015 Fax: (90) CSAS-PREVENTION DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 1 BOYS AND GIRLS CLUB OF OSHKOSH, 501 E PARKWAY AVE., OSHKOSH, WI /01/016 10/1/015 1 CATALPA HEALTH - CASALOMA CAMPUS, 190 N CASALOMA ST, APPLETON, WI /14/015 10/1/015 1 CHILD ADVOCACY CENTER, 5 N COMMERCIAL STREET, NEENAH, WI /01/01 0/1/014 CATALPA HEALTH ACCESS CENTER, 44 WESTHILL BLVD., APPLETON, WI CATALPA HEALTH, 181 WITZEL AVE, OSHKOSH, WI 5490 BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 08 EAST BURDICK ST, BLACK CREEK, WI FREEDOM ELEMENTARY SCHOOL, N569 COUNTY ROAD E, FREEDOM, WI 5411 FREEDOM HIGH & MIDDLE SCHOOLS, N401 COUNTY ROAD E, FREEDOM, WI 5411 GREENVILLE ELEMENTARY SCHOOL, W68 GREENRIDGE DR., GREENVILLE, WI 5494 GREENVILLE MIDDLE SCHOOL, N1450 FAWN RIDGE DR., GREENVILLE, WI 5494 HORIZON ELEMENTARY SCHOOL, 101 SCHAEFER CIRCLE, APPLETON, WI HORTONVILLE ELEMENTARY SCHOOL, 40 WARNER ST., HORTONVILLE, WI HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 0, HORTONVILLE, WI HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST; PO BOX 59, HORTONVILLE, WI MADISON MIDDLE SCHOOL, 00 S. CARPENTER STREET, APPLETON, WI MENASHA HIGH SCHOOL, 40 SEVENTH STREET, MENASHA, WI 5495 NORTH GREENVILLE ELEMENTARY SCHOOL, N468 LEARNING WAY, GREENVILLE, WI 5494 OSHKOSH NORTH HIGH SCHOOL, 1100 W. SMITH AVE., OSHKOSH, WI ROCKLEDGE PRIMARY/INTERMEDIATE CENTERS, 0 WEST HICKORY ST, SEYMOUR, WI ROOSEVELT MIDDLE SCHOOL, 18 EAST BREWSTER ST, APPLETON, WI SEYMOUR MIDDLE & HIGH SCHOOLS, 10 CIRCLE DRIVE, SEYMOUR, WI SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI WASHINGTON ELEMENTARY SCHOOL, 99 WINNEBAGO AVE, OSHKOSH, WI WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI /17/014 10/1/015 07/01/014 10/1/015 04/16/014 10/1/015 04/16/014 10/1/015 04/16/014 10/1/015 09/04/015 10/1/015 09/04/015 10/1/015 08/18/014 10/1/015 09/04/015 10/1/015 09/04/015 10/1/015 09/04/015 10/1/015 08/18/014 10/1/015 01/01/015 10/1/015 09/04/015 10/1/015 08/19/015 10/1/015 04/16/014 10/1/015 08/18/014 10/1/015 04/16/014 10/1/015 04/16/014 10/1/015 0/01/014 10/1/015 08/18/014 10/1/015 09/9/015 Page 86 of 1

87 LUTHERAN SOCIAL SERVICES 00 B NORTH RICHMOND ST APPLETON, WI Outagamie County Lic #: 87 REBECKA HELDT Initial Cert: 06/0/009 [email protected] Phone: (90) /01/015 08/1/016 Fax: (90) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 1 LSS- OSHKOSH OLDER ADULT PROGRAMS, 00 N CAMPBELL, OSHKOSH, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 115 NORTH 6TH STREET, WAUSAU, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1500 DOUGLAS DRIVE, PLYMOUTH, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1777 WEST MAIN STREET STE 1, SUN PRAIRIE, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 445 PARK AVENUE, BELOIT, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 706 N 9TH STREET, SHEBOYGAN, WI /01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 74 SOUTH MAIN ST #10, FOND DU LAC, WI /01/015 08/1/016 LUTHERAN SOCIAL SERVICES, 81 N GRANDVIEW BLVD #09, PEWAUKEE, WI 507 LUTHERAN SOCIAL SERVICES, NORTH 5TH STREET EAST, SUPERIOR, WI LUTHERAN SOCIAL SERVICES, 61 N RANDALL STREET, JANESVILLE, WI 5545 LUTHERAN SOCIAL SERVICES, 614 ODANA ROAD, MADISON, WI 5719 LUTHERAN SOCIAL SERVICES, 809 N PARK AVENUE, BEAVER DAM, WI 5916 LUTHERAN SOCIAL SERVICES, 80 W COLLEGE AVENUE, APPLETON, WI APPLETON EAST HIGH SCHOOL, 11 NORTH EMMERS DRIVE, APPLETON, WI APPLETON WEST HIGH SCHOOL, 610 NORTH BADGER AVE, APPLETON, WI CLOVIS GROVE ELEMENTARY SCHOOL, 974-9TH STREET, MENASHA, WI 5495 LINCOLN ELEMENTARY SCHOOL, 1000 NORTH MASON ST, APPLETON, WI LSS - NORTHERN LIGHTS ELEMENTARY SCHOOL, 101 NORTH 8TH ST, SUPERIOR, WI LSS - SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI LSS - SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI MENASHA HIGH SCHOOL, 40-7TH STREET, MENASHA, WI 5495 RANDON LAKE HIGH SCHOOL, 605 RANDOM LAKE ROAD, RANDOM LAKE, WI 5075 WILSON MIDDLE SCHOOL, 5 N BADGER AVE, APPLETON, WI /01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 09/04/015 08/1/016 09/01/015 08/1/016 MILWAUKEE HEALTH SERVICE SYSTEMS D/B/A VALLEY HEALTH SERVICES Lic #: N BALLARD RD SUITE B APPLETON, WI Outagamie County JANE WILLIQUETTE Initial Cert: 07/09/1990 [email protected] Phone: (90) /01/015 06/0/017 Fax: (90) CSAS-NARCOTIC TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 87 of 1

88 MOORING PROGRAMS, INC. 607 W. SEVENTH STREET APPLETON, WI Outagamie County Lic #: 1917 JAMIE LOEHNIS Initial Cert: 05/08/1991 Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-RESIDENTIAL INTOXICATION MONITORING DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVCIES Lic #: S ELM STREET APPLETON, WI Outagamie County JUDY VAN RYZIN Initial Cert: 04/01/005 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 ST. ELIZABETH HOSPITAL 1506 S. ONEIDA STREET APPLETON, WI Outagamie County Lic #: 1860 STEVIE REICH Initial Cert: 0/01/1984 [email protected] Phone: (90) /01/01 10/1/015 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 WI LUTHERAN CHILD & FAMILY SERVICE, INC. D/B/A CHRISTIAN FAMILY COUNSELING Lic #: N LYNNDALE DRIVE, #1B APPLETON, WI Outagamie County DR MYLES TONNACLIFF Initial Cert: 05/01/1990 [email protected] Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 1 WINNEBAGO LUTHERAN ACADEMY, 475 E MERRILL AVE, FOND DU LAC, WI /7/015 08/1/016 1 WLCFS INC - CHRISTIAN FAMILY COUNSELING, 757 S MAIN STREET, FOND DU LAC, WI /01/014 08/1/016 09/9/015 Page 88 of 1

89 Ozaukee County NORTHSHORE CLINIC & CONSULTANTS, INC. W6 N48 WASHINGTON AVE., #07 CEDARBURG, WI 501 Ozaukee County Lic #: 1695 JOY MYERS Initial Cert: 10/01/1987 Phone: (6) /01/015 07/1/017 Fax: (6) /01/015 07/1/017 08/01/015 07/1/017 1 NORTHSHORE CLINIC & CONSULTANTS, 07 E BUFFALO STREET, #510, MILWAUKEE, WI 50 08/01/015 07/1/017 NORTHSHORE CLINIC & CONSULTANTS, 6 S 10ND STREET, #0, WEST ALLIS, WI 57 NORTHSHORE CLINIC & CONSULTANTS, INC., 1615 BARTON AVENUE, WEST BEND, WI /01/015 07/1/017 08/01/015 07/1/017 ALARUS HEALTHCARE, LLC 1971 WASHINGTON ST SUITE 00 GRAFTON, WI 504 Ozaukee County Lic #: 009 MICHAEL J. OWEN Initial Cert: 10/08/01 [email protected] Phone: (6) /01/014 09/0/016 Fax: (6) CSAS-DAY TREATMENT DHS /01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 ALARUS HEALTHCARE - WEST BEND, 16 CHESTNUT ST., WEST BEND, WI /06/015 09/0/016 ACHIEVEMENT ASSOCIATES, LTD. 117 W. TOWNE SQUARE ROAD MEQUON, WI 509 Ozaukee County Lic #: 1009 NEENA FLORSHEIM Initial Cert: 05/01/1998 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) /01/015 05/1/017 06/01/015 05/1/017 09/9/015 Page 89 of 1

90 AMERICAN BEHAVIORAL CLINICS 140 W RANCHITO LANE MEQUON, WI 509 Ozaukee County Lic #: 68 JAY SCHRINSKY Initial Cert: 05/01/00 [email protected] Phone: (6) /01/014 05/1/016 Fax: (6) /01/014 05/1/016 07/01/014 05/1/016 1 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #, 970 W BLUEMOUND ROAD, MILWAUKEE, WI 5 07/01/014 05/1/016 AMERICAN BEHAVIORAL CLINICS-BLUEMOUND #1, 1044 W BLUEMOUND ROAD, MILWAUKEE, WI 5 AMERICAN BEHAVIORAL CLINICS-ELM GROVE, 1585 WATERTOWN PLANK ROAD, ELM GROVE, WI 5 AMERICAN BEHAVIORAL CLINICS-LAYTON, 70 W LAYTON AVENUE, MILWAUKEE, WI 50 07/01/014 05/1/016 07/01/014 05/1/016 07/01/014 05/1/016 COLUMBIA ST MARY'S BEHAVIORAL MEDICINE-MEQUON Lic #: N PORT WASHINGTON ROAD MEQUON, WI 5097 Ozaukee County WILLIAM FRY Initial Cert: 09/0/00 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 COLUMBIA ST. MARY'S OZAUKEE HOSPITAL BEHAVIORAL HEALTH UNIT Lic #: N PORT WASHINGTON RD MEQUON, WI 5097 Ozaukee County BILL FRY Initial Cert: 09/01/1984 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 0/9/016 0/01/014 0/9/016 DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY Lic #: W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 [email protected] Phone: (6) /01/014 09/0/016 Fax: (6) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 1 OZAUKEE COUNTY JAIL, 101 S. SPRING STREET, PORT WASHINGTON, WI /10/016 09/0/016 09/9/015 Page 90 of 1

91 OZAUKEE COUNTY CCS PROGRAM 11 W MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County Lic #: 050 LIZA DRAKE Initial Cert: 09//014 [email protected] Phone: (6) /01/015 09/0/016 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 10/01/015 09/0/016 Pierce County PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: W KINNE STREET ELLSWORTH, WI Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 1/01/1981 [email protected] Phone: (715) /01/015 0/1/017 Fax: (715) /01/015 0/1/017 04/01/015 0/1/017 KINNIC FALLS ALCOHOL AND DRUG ABUSE SERVICES, INC. Lic #: S. ORANGE STREET RIVER FALLS, WI 540 Pierce County Surveyor: Roderic Senn JENNIFER HAGEN Initial Cert: 05/01/1990 [email protected] Phone: (715) /01/015 04/0/017 Fax: (715) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 04/0/017 Polk County POLK COUNTY MENTAL AND BEHAVIORAL HEALTH SERVICES Lic #: POLK COUNTY PLAZA #50 BALSAM LAKE, WI Polk County Surveyor: Roderic Senn KRISTIN BOLAND Initial Cert: 0/08/000 [email protected] Phone: (715) /01/014 04/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 09/9/015 Page 91 of 1

92 Portage County OSWALD COUNSELING ASSOCIATES 450 VINEYARD DRIVE PLOVER, WI Portage County Surveyor: Hannah Whaley Lic #: 566 LYNNE OSWALD Initial Cert: 01/14/005 Phone: (715) /01/014 1/1/015 Fax: (715) /01/014 1/1/015 01/01/014 1/1/015 ACS CLINICAL SERVICES, LLC - STEVENS POINT Lic #: B CHURCH STREET STEVENS POINT, WI Portage County Surveyor: Erin Taylor MARK ROSSANO Initial Cert: 09/15/009 [email protected] Phone: (715) /01/014 09/0/016 Fax: (715) /01/014 09/0/016 10/01/014 09/0/016 1 ACS CLINICAL SERVICES LLC - SPARTA, 101 SOUTH WATER STREET, SPARTA, WI /01/014 09/0/016 1 ACS CLINICAL SERVICES, LLC - WAUSAU, 90 ND STREET, WAUSAU, WI /9/014 09/0/016 1 ACS CLINICAL SERVICES, LLC-SCHOFIELD, 11 SKELLY STREET, SCHOFIELD, WI /01/014 10/8/014 MINISTRY BEHAVIORAL HEALTH 01 PRENTICE STREET NORTH STEVENS POINT, WI Portage County Surveyor: Erin Taylor Lic #: 116 LAURIE ROBERTS Initial Cert: 10/01/1990 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) 45-0 CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 06/0/017 07/01/015 06/0/017 MINISTRY BEHAVIORAL HEALTH 09 PRENTICE STREET NORTH STEVENS POINT, WI Portage County Surveyor: Erin Taylor Lic #: 117 LAURIE ROBERTS Initial Cert: 05/01/1991 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) CSAS-DAY TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 9 of 1

93 PORTAGE COUNTY HEALTH & HUMAN SERVICES Lic #: WHITING AVENUE STEVENS POINT, WI Portage County Surveyor: Erin Taylor AMY MARCOTT Initial Cert: 06/01/1976 Phone: (715) /01/015 0/1/017 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 04/01/015 0/1/017 04/01/015 0/1/017 04/01/015 0/1/017 PORTAGE COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: WHITING AVENUE STEVENS POINT, WI Portage County Surveyor: Erin Taylor AMY MARCOTT Initial Cert: 0/01/007 Phone: (715) /01/015 0/8/017 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 RIVERWOOD COUNSELING ASSOCIATES LLC 105 MAIN STREET, #0 STEVENS POINT, WI Portage County Surveyor: Hannah Whaley Lic #: 0 ROBERT A MILLER Initial Cert: 07/17/000 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) /01/014 06/0/016 07/01/014 06/0/016 SAINT MICHAEL'S HOSPITAL 900 ILLINOIS AVENUE STEVENS POINT, WI Portage County Surveyor: Erin Taylor Lic #: 180 LAURIE ROBERTS Initial Cert: 05/01/1978 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 09/0/017 10/01/015 09/0/017 09/9/015 Page 9 of 1

94 Price County COUNSELING AND DEVELOPMENT CENTER, INC. Lic #: CHESTNUT STREET PHILLIPS, WI Price County Surveyor: Polly Wong KELLY J. SCHULTZ Initial Cert: 08/01/198 Phone: (715) /01/015 07/1/017 Fax: (715) 9-46 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 1 COUNSELING & DEVELOPMENT CENTER, 14-4TH AVENUE N, PARK FALLS, WI /01/015 07/1/017 09/9/015 Page 94 of 1

95 Racine County AGAPE RECOVERY CENTER 01 N PINE BURLINGTON, WI 5105 Racine County Surveyor: William Rohner Lic #: 10 PATRICIA A GRAMKE Initial Cert: 04/01/1994 [email protected] Phone: (6) /01/015 0/1/017 Fax: (6) /01/015 0/1/017 BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY Lic #: TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 08/0/01 [email protected] Phone: (6) /01/015 07/1/017 Fax: (6) CSAS-PREVENTION DHS /01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 GENESIS BEHAVIORAL SERVICES RACINE OUTPATIENT CLINIC Lic #: WASHINGTON AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/01/1989 [email protected] Phone: (414) /01/014 0/9/016 Fax: (414) 6-98 CSAS-DAY TREATMENT DHS /01/014 0/9/016 0/01/014 0/9/016 GENESIS BEHAVIORAL SERVICES, INC. CHATHAM HOUSE Lic #: CHATHAM STREET RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/01/008 [email protected] Phone: (6) /01/015 0/8/017 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 0/8/017 0/01/015 0/8/017 09/9/015 Page 95 of 1

96 GENESIS BEHAVIORAL SERVICES, INC. CROSSROADS Lic #: ST CLAIR STREET RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 09/01/1994 Phone: (6) /01/015 08/1/017 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 08/1/017 09/01/015 08/1/017 GENESIS BEHAVIORAL SERVICES, INC. SPRING PLACE Lic #: SPRING PLACE RACINE, WI 5404 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 04/09/007 Phone: (6) /01/015 04/0/017 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 04/0/017 05/01/015 04/0/017 HARVEST CONSULTING COMPANY, LLC 405 NORTHWESTERN AVE, LL0 RACINE, WI 5404 Racine County Surveyor: William Rohner Lic #: 98 CORIE HARGROVE Initial Cert: 11/0/01 Phone: (6) /01/01 11/0/015 Fax: (6) CSAS-AMBULATORY DETOXIFICATION DHS /01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 QAM-QUALITY ADDICTION MANAGMENT 575 DURAND AVENUE RACINE, WI 5406 Racine County Surveyor: William Rohner Lic #: 41 CHARLES SCHRAUTH Initial Cert: 11/1/001 Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-NARCOTIC TREATMENT DHS /01/014 08/1/016 09/01/014 08/1/016 09/9/015 Page 96 of 1

97 RACINE COUNTY CCS 1717 TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 01 MICHELLE GOGGINS Initial Cert: 05/08/014 Phone: (6) /01/015 05/1/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 06/01/015 05/1/017 RACINE COUNTY HUMAN SERVICES DEPARTMENT Lic #: TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 01/14/004 [email protected] Phone: (6) /01/015 1/1/016 Fax: (6) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 01/01/015 1/1/016 01/01/015 1/1/016 WHEATON FRANCISCAN HEALTHCARE ALL SAINTS MENTAL HEALTH & ADDICTION CARE Lic #: WISCONSIN AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner KAREN MOLNAR-SMITH Initial Cert: 07/01/1990 [email protected] Phone: (6) /01/014 06/0/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS /01/014 06/0/016 07/01/014 06/0/016 01/06/015 06/0/016 01/06/015 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 408 FOUR MILE ROAD, RACINE, WI /06/015 06/0/016 1 WHEATON FRANCISCAN MEDICAL GROUP - NEUROLOGY, 805 B SPRING ST., RD FLOOR, RACINE, W 04//015 06/0/016 1 WHEATON FRANCISCAN MEDICAL GROUP - UNION GROVE, 110 MAIN STREET, UNION GROVE, WI 5 01/06/015 06/0/016 WHEATON FRANCISCAN HEALTHCARE - ALL SAINTS, 805B SPRING STREET #40, RACINE, WI 540 WHEATON FRANCISCAN HEALTHCARE-SPRING STREET CAMPUS, 81 SPRING STREET, RACINE, W WHEATON FRANCISCAN MED GRP - FAMILY MED CLINIC, 807 SPRING ST., RD FLOOR NORTH, RAC WHEATON FRANCISCAN MED GRP-CENTER FOR ADDICTION, 805 B SPRNG STREET, LL-0, RACINE WHEATON FRANCISCAN MEDICAL GROUP-ALL SAINTS, 48 OLD GREEN BAY ROAD, RACINE, WI 54 01/06/015 06/0/016 08/01/015 06/0/016 0/04/015 06/0/016 08/01/015 06/0/016 08/01/015 06/0/016 09/9/015 Page 97 of 1

98 ZCI-1 54 MAIN STREET, #0 RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 66 CHERYL ZIMMERMAN, PHD Initial Cert: 01/10/006 Phone: (6) /01/015 01/1/017 Fax: (6) CSAS-DAY TREATMENT DHS /01/015 01/1/017 0/01/015 01/1/017 Ramsey County (MN) Richland County RICHLAND COUNTY HEALTH & HUMAN SERVICES Lic #: W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren KATIE ERB Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 RICHLAND COUNTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 56 1 W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren KATIE ERB Initial Cert: 01/01/005 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 07/01/014 1/1/015 01/01/014 06/0/014 09/9/015 Page 98 of 1

99 Rock County BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER Lic #: W. HART ROAD BELOIT, WI 5511 Rock County Surveyor: William Rohner GREG AMMON Initial Cert: 07/01/1985 Phone: (608) /01/014 11/0/016 Fax: (608) /01/014 11/0/016 1/01/014 11/0/016 1 BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI /01/014 11/0/016 1 JANESVILLE OCCUPATIONAL HEALTH, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI /01/014 11/0/016 BELOIT MEMORIAL HIGH SCHOOL, 15 4TH STREET, BELOIT, WI /01/014 11/0/016 QUALITY ADDICTION MANAGEMENT, INC. 40 PRAIRIE AVENUE, #10 BELOIT, WI 5511 Rock County Surveyor: William Rohner Lic #: 686 WENDY KOHLHAAS Initial Cert: 10/06/006 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) CSAS-NARCOTIC TREATMENT DHS /01/015 09/0/017 10/01/015 09/0/017 GENESIS COUNSELING SERVICES, LTD. ONE S MAIN STREET JANESVILLE, WI 5545 Rock County Surveyor: Cynthia Lindgren Lic #: 181 JAMES BURNS PHD Initial Cert: 07/01/1988 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) /01/015 06/0/016 07/01/015 06/0/016 MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM Lic #: MINERAL POINT AVENUE JANESVILLE, WI 5548 Rock County Surveyor: William Rohner BELINDA WELLNITZ Initial Cert: 05/18/01 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS /01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 99 of 1

100 MERCY OPTIONS - MERCY HEALTH SYSTEMS 1000 MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner Lic #: 161 LISA USGAARD Initial Cert: 10/01/1984 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 06/0/017 07/01/015 06/0/017 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE Lic #: MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 01/01/199 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) /01/014 1/1/015 01/01/014 1/1/015 1 MERCY MALL CLINIC, 1010 N WASHINGTON, JANESVILLE, WI /01/014 1/1/015 1 MERCY CLINIC NORTH, 400 DEERFIELD DRIVE, JANESVILLE, WI /01/014 1/1/015 1 MERCY EAST CLINIC, 54 E MILWAUKEE STREET, JANESVILLE, WI /01/014 1/1/015 1 MERCY EDGERTON MEDICAL CENTER, 17 N MAIN ST, EDGERTON, WI /01/014 11/0/014 1 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MILTON, 75 S. JANESVILLE ST, MILTON, WI 556 1/01/014 1/1/015 1 MERCY OPTIONS-OUTPATIENT SERVICES, 507 W MAIN ST, WHITEWATER, WI /01/014 1/1/015 1 MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI /01/014 1/1/015 MERCY BELOIT CLINIC, 85 PRAIRIE AVENUE, BELOIT, WI 5511 MERCY EVANSVILLE CLINIC, 00 UNION STREET, EVANSVILLE, WI 556 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC - MERCYCARE, 580 N. WASHINGTON ST., JANESVILLE MERCY OPTIONS BH CLINIC - WALWORTH, N846 STATE ROAD 67, WILLIAMS BAY, WI /01/014 1/1/015 01/01/014 1/1/015 04/06/015 1/1/015 01/01/014 1/1/015 MERCY OPTIONS CHILD AND ADOLESCENT DAY TREATMENT Lic #: EAST COURT ST JANESVILLE, WI 5547 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 07/01/007 [email protected] Phone: (608) /01/015 06/0/017 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 age 100 of 1

101 ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: NORTH COUNTY HWY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATE FLANAGAN Initial Cert: 07/01/014 [email protected] Phone: (608) /01/015 06/0/016 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 1 ROCK COUNTY COMPREHENSIVE COMMUNITY SVS, 11 SOUTH FRANKLIN ST, JANESVILLE, WI /01/015 06/0/016 ROCK COUNTY COUNSELING CENTER 11 S FRANKLIN STREET JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren Lic #: 1807 KATE FLANNAGAN Initial Cert: 10/01/1975 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) /01/014 08/1/016 09/01/014 08/1/016 1 ROCK CNTY CNSLNG CTR - HEALTHCARE CTR BRANCH, 50 N COUNTY TRK HWY F, JANESVILLE, W 09/01/014 08/1/016 1 ROCK COUTNY JOB CENTER, 1900 CENTER AVENUE, JANESVILLE, WI /01/015 08/1/016 COURT STREET BRANCH OFFICE, 0 W. COURT ST., JANESVILLE, WI 5548 ROCK CNTY CNSLNG CTR - BELOIT BRANCH, 64 ECLIPSE CENTER, BELOIT, WI /7/015 08/1/016 09/01/014 08/1/016 ROCK VALLEY COMMUNITY PROGRAMS INC 0 W SUNNY LANE ROAD JANESVILLE, WI 5546 Rock County Surveyor: William Rohner Lic #: 1809 ANGEL EGGERS Initial Cert: 0/01/1990 [email protected] Phone: (608) /01/014 0/9/016 Fax: (608) /01/014 0/9/016 0/01/014 0/9/016 JANESVILLE PSYCHIATRIC CLINIC, 15 W. MILWAUKEE ST., #07, JANESVILLE, WI /5/015 0/9/016 TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: S RIVER STREET #54 JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren TIM PERRY Initial Cert: 09/01/1977 [email protected] Phone: (608) /01/015 09/0/017 Fax: (608) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 1 CROSSROADS COUNSELING CENTER, 778 LOIS DRIVE, SUN PRAIRIE, WI /01/015 09/0/017 Rusk County 09/9/015 age 101 of 1

102 Saint Croix County BURKWOOD TREATMENT CENTER 615 OLD MILL ROAD HUDSON, WI Saint Croix County Surveyor: Roderic Senn Lic #: 1118 CHARLES BROOKS Initial Cert: 0/01/1988 Phone: (715) /01/014 04/0/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS /01/014 04/0/016 05/01/014 04/0/016 HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE Lic #: DOMINION DRIVE HUDSON, WI Saint Croix County Surveyor: Roderic Senn PETER VAN DUSARTZ Initial Cert: 09/01/1990 Phone: (715) /01/01 11/0/015 Fax: (715) /01/01 11/0/015 06//015 11/0/015 1 HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI //015 11/0/015 1 WESTFIELDS HOSPITAL, 55 HOSPITAL ROAD, NEW RICHMOND, WI /01/01 11/0/015 ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH Lic #: DORSET LANE NEW RICHMOND, WI Saint Croix County Surveyor: Roderic Senn STEVE KIRT Initial Cert: 10/01/1975 [email protected] Phone: (715) /01/014 11/0/016 Fax: (715) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 Saint Louis County (MN) CENTER FOR ALCOHOL & DRUG TREATMENT DETOX Lic #: E. SUPERIOR STREET DULUTH, MN Saint Louis County (MN) Surveyor: Polly Wong TINA SILVERNESS-ZINMER Initial Cert: 09/01/1998 [email protected] Phone: (18) /01/015 1/1/016 Fax: (18) CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS /01/015 1/1/016 09/9/015 age 10 of 1

103 Sauk County SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: BROADWAY BARABOO, WI 591 Sauk County Surveyor: Erin Taylor SHARON BOESL Initial Cert: 0/01/007 Phone: (608) /01/015 0/8/017 Fax: (608) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 1 SAUK COUNTY DEPT HUMAN SERVICES REEDSBURG, 45-6TH STREET, REEDSBURG, WI /01/015 0/8/017 SAUK COUNTY DEPARMENT OF HUMAN SERVICES Lic #: BROADWAY STREET BARABOO, WI 591 Sauk County Surveyor: Hannah Whaley SHARON BOESL Initial Cert: 01/01/1988 [email protected] Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 SAUK COUNTY DHS - REEDSBURG OFFICE, 45 SIXTH STREET, REEDSBURG, WI /01/014 1/1/015 ST. CLARE CENTER, ST. CLARE HOSPITAL 1510 JEFFERSON STREET BARABOO, WI 591 Sauk County Surveyor: Hannah Whaley Lic #: 087 JUDY HANNAFORD Initial Cert: 11/5/1998 [email protected] Phone: (608) /01/014 01/1/016 Fax: (608) CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS /01/014 01/1/016 0/01/014 04/0/015 0/01/014 01/1/016 0/01/014 01/1/016 0/01/014 01/1/016 ST. CLARE HOSPITAL & HEALTH SERVICES TH STREET BARABOO, WI 591 Sauk County Surveyor: Hannah Whaley Lic #: 586 MARY SCHWARTZ Initial Cert: 07/01/004 [email protected] Phone: (608) /01/014 0/1/016 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS /01/014 0/1/016 09/9/015 age 10 of 1

104 PATHWAY CLINIC SC 560-4TH STREET PRAIRIE DU SAC, WI 5578 Sauk County Surveyor: Hannah Whaley Lic #: 179 TAMMY KIRCH Initial Cert: 09/01/1984 Phone: (608) /01/014 1/1/015 Fax: (608) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 GOODMAN'S BEHAVIORAL HEALTH CLINIC LLC ST STREET SUITE E REEDSBURG, WI 5959 Sauk County Surveyor: Erin Taylor Lic #: 774 BARBARA GOODMAN Initial Cert: 0/06/008 [email protected] Phone: (608) /01/015 0/8/017 Fax: (608) /01/015 0/8/017 0/01/015 0/8/017 09/9/015 age 104 of 1

105 Sawyer County LAC COURTE ORIELLES COMMUNITY HEALTH CENTER Lic #: W TREPANIA ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong JENNY INGRAM Initial Cert: 0/01/1987 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-DAY TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHWEST OASIS, US HWY 6, HAYWARD, WI /01/014 06/0/016 LAC COURTE OREILLES OJIBWE SCHOOL, 8575 N. TREPANIA ROAD, HAYWARD, WI /01/014 06/0/016 NOO JII MOO WII GA MIEG (LAC COURTE OREILLES HALFWAY HOUSE) Lic #: W HASKINS ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong DOROTHY CRUST Initial Cert: 07/18/00 [email protected] Phone: (715) /01/015 09/0/015 Fax: (715) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 09/0/015 SAWYER COUNTY HEALTH & HUMAN SERVICES/INFORMATION & REFERRAL CENTER Lic #: MAIN ST SUITE 4 HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong ALICIA CARLSON Initial Cert: 04/01/1979 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 TRANSITION HOUSE, 1608 WOOD RIDGE LANE, HAYWARD, WI /0/015 06/0/016 09/9/015 age 105 of 1

106 Shawano County STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER Lic #: 188 W180 COUNTY HWY A BOWLER, WI Shawano County DELWAR MIAN Initial Cert: 06/19/014 [email protected] Phone: (715) /01/015 07/1/016 Fax: (715) /01/015 07/1/016 08/01/015 07/1/016 MAEHNOWESEKIYAH WELLNESS CENTER N150 KESAEHKAHTEK GRESHAM, WI 5418 Shawano County Lic #: 1554 STEVE DAKAI Initial Cert: 11/1/1989 [email protected] Phone: (715) /01/01 11/0/015 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-PREVENTION DHS /01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 1/01/01 11/0/015 SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER Lic #: LAKELAND ROAD SHAWANO, WI Shawano County JESSICA DELZER Initial Cert: 0/01/1977 [email protected] Phone: (715) /01/015 1/1/016 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 SHAWANO COUNTY DEPARTMENT OF HUMAN SERVICES - LAKELAND CENTER CCS Lic #: LAKELAND ROAD SHAWANO, WI Shawano County JESSICA DELZER Initial Cert: 05/06/014 [email protected] Phone: (715) /01/015 06/0/017 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 age 106 of 1

107 SHAWANO MEDICAL CENTER 09 N. BARTLETT STREET SHAWANO, WI Shawano County Lic #: 18 PENNY BLOCK Initial Cert: 10/01/1978 Phone: (715) /01/014 0/1/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS /01/014 0/1/016 09/9/015 age 107 of 1

108 Sheboygan County EXODUS TRANSITIONAL CARE FACILITY, INC. 141 FOND DU LAC AVENUE KEWASKUM, WI 5040 Sheboygan County Lic #: 598 CRAIG BRUESEWITZ Initial Cert: 01/01/005 Phone: (6) /01/014 1/1/015 Fax: (6) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 1/1/015 LIFE POINT COUNSELING, LLC 4A EAST MILL STREET PLYMOUTH, WI 507 Sheboygan County Lic #: 677 KATHLYN M HUNHOLZ Initial Cert: 07/06/006 [email protected] Phone: (90) /01/014 07/1/016 Fax: (90) /01/014 07/1/016 1 LIFE POINT COUNSELING, LLC, 601 N. 5TH STREET, SHEBOYGAN, WI /11/015 07/1/016 AURORA SHEBOYGAN CLINIC 414 KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 195 TRACY LEE-JOHNSON Initial Cert: 07/01/1986 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 07/01/014 06/0/016 1 AURORA SHEBOYGAN CLINIC, 600 KILEY WAY, PLYMOUTH, WI /01/014 06/0/016 AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER Lic #: N 7TH STREET SHEBOYGAN, WI 508 Sheboygan County LORI KNITT Initial Cert: 05/01/1987 [email protected] Phone: (90) /01/014 04/0/016 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 09/9/015 age 108 of 1

109 GENESIS SHEBOYGAN RESIDENTIAL PROGRAM Lic #: E. WISCONSIN AVENUE SHEBOYGAN, WI 5081 Sheboygan County GINA SINGLETERY Initial Cert: 11/01/1991 Phone: (90) /01/014 10/1/015 Fax: (90) CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 10/1/015 NETT-WORK FAMILY COUNSELING, LLC 801 CALUMET DRIVE SHEBOYGAN, WI 508 Sheboygan County Lic #: 1656 CHRISTINE L. NETT Initial Cert: 0/7/1998 Phone: (90) /01/014 0/9/016 Fax: (90) /01/014 0/9/016 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, TH STREET #1, MANITOWOC, WI 540 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 140 MILWAUKEE DR, NEW HOLSTEIN, WI /01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 61 E MILL ST, PLYMOUTH, WI 507 0/01/014 0/9/016 NETT-WORK FAMILY COUNSELING, LLC, 1 SOUTH 1TH ST, SHEBOYGAN, WI /01/014 0/9/016 NORTHSHORE CLINIC LLC 805 NORTH 6TH STREET SHEBOYGAN, WI 5081 Sheboygan County Lic #: 1699 LORI DIELENTHEIS Initial Cert: 08/01/1991 [email protected] Phone: (90) /01/014 01/1/016 Fax: (90) /01/014 01/1/016 0/01/014 01/1/016 QUALITY ADDICTION MANAGEMENT 84 S BUSINESS DRIVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 91 CHARLES SCHRAUTH Initial Cert: 01/0/011 [email protected] Phone: (90) /01/015 1/1/016 Fax: (90) CSAS-NARCOTIC TREATMENT DHS /01/015 1/1/016 01/01/015 1/1/016 09/9/015 age 109 of 1

110 SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County JODY A GALLAWAY, PSYD Initial Cert: 07/01/1986 [email protected] Phone: (90) /01/014 09/0/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 SHEBOYGAN COUNTY HEALTH & HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County AMY CULVER Initial Cert: 05/01/006 [email protected] Phone: (90) /01/014 05/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 05/1/016 06/01/014 1/1/014 ST. JOSEPH'S HOSPITAL - HOSPITAL SISTERS- THIRD ORDER OF ST FRANCIS DBA LIBERTAS Lic #: KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 5081 Sheboygan County BARBARA CONIFF Initial Cert: 01/16/1988 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) /01/015 0/1/017 ST. NICHOLAS HOSPITAL DBA PREVEA HEALTH 45 SUPERIOR AVE SHEBOYGAN, WI 5081 Sheboygan County Lic #: 070 JEFF STUMBRAS Initial Cert: 10/7/014 [email protected] Phone: (90) /7/014 10/1/015 Fax: (90) /7/014 10/1/015 10/7/014 10/1/015 09/9/015 age 110 of 1

111 Taylor County COUNSELING CONNECTION OF MEDFORD 1 WEST STATE STREET, #4 MEDFORD, WI Taylor County Surveyor: Polly Wong Lic #: 75 KELLY SCHULTZ Initial Cert: 09/01/007 [email protected] Phone: (715) /01/014 08/1/016 Fax: (715) /01/014 08/1/016 09/01/014 08/1/016 1 CADOTT MEDICAL CENTER-COUNSELING CONNECTION, NORTH MAIN ST, CADOTT, WI /01/014 08/1/016 1 PHOENIX HOUSE, 600 W. HICKORY STREET, GILMAN, WI /1/016 08/1/016 COLBY MIDDLE SCHOOL, 70 NORTH ND ST, COLBY, WI 5441 MEDFORD ELEMENTARY SCHOOL-COUNSELING CONNECTION, 1065 W BROADWAY AVE, MEDFORD, MEDFORD MIDDLE SCHOOL-COUNSELING CONNECTION, 509 CLARK ST, MEDFORD, WI /01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 EVOLVE WITH KAREN COUNSELING SERVICE 1 W STATE STREET MEDFORD, WI Taylor County Surveyor: Polly Wong Lic #: 05 KAREN MUNDT Initial Cert: 09/04/014 [email protected] Phone: (715) /01/015 08/1/017 Fax: 09/01/015 08/1/017 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT Lic #: E. COLLEGE STREET MEDFORD, WI Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 06/01/198 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT CCS PROGRAM Lic #: E COLLEGE ST MEDFORD, WI Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 07/01/015 [email protected] Phone: (715) /01/015 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 09/9/015 Page 111 of 1

112 Trempealeau County WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC Lic #: WHITEHALL RD INDEPENDENCE, WI Trempealeau County Surveyor: Roderic Senn TODD PYKA Initial Cert: 09/0/004 Phone: (715) /01/015 08/1/017 Fax: (715) 84-8 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 TREMPEALEAU COUNTY HUMAN SERVICES - CCS Lic #: MAIN ST WHITEHALL, WI 5477 Trempealeau County Surveyor: Roderic Senn DEBRA SUCHLA Initial Cert: 09/01/015 [email protected] Phone: (715) /01/015 08/1/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 CCS REGIONAL MODEL SHARED SERVICES W/TELEHEALTH DHS 6 09/01/015 08/1/016 09/01/015 08/1/016 09/9/015 age 11 of 1

113 Vernon County CENTER POINT COUNSELING SERVICES COOPERATIVE Lic #: AIRPORT RD SUITE 10 VIROQUA, WI Vernon County SHERI HAMMOND Phone: (608) Fax: (608) Initial Cert: 1/01/ BETHEL HOME & SERVICES, 614 SOUTH ROCK AVENUE, VIROQUA, WI BETHEL HOME & SERVICES, 60 SOUTH GARFIELD, VIROQUA, WI CENTER POINT CNSLNG SVS VERNON MANOR, E7404A COUNTY ROAD BB, VIROQUA, WI COON VALLEY ELEMENTARY SCHOOL, 00 LIEN STREET, COON VALLEY, WI 546 VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DRIVE, VIROQUA, WI VIROQUA ELEMENTARY SCHOOL, 115 NORTH EDUCATION AVE, VIROQUA, WI WESTBY ELEMENTARY SCHOOL, 1 NELSON STREET, WESTBY, WI WESTBY MIDDLE & HIGH SCHOOL, 06 WEST AVENUE SOUTH, WESTBY, WI STRIVE COMPREHENSIVE COMMUNITY SERVICES Lic #: FAIRLANE DRIVE SUITE 100 VIROQUA, WI Vernon County Surveyor: Roderic Senn REBECCA MILLER Initial Cert: 08/01/015 [email protected] Phone: (608) /01/015 07/1/016 Fax: (608) CCS REGIONAL MODEL MULTI-COUNTY DHS 6 08/01/015 07/1/016 CRAWFORD CO DEPT. OF HUMAN SERVICES, 5 N. BEAUMONT RD SUITE 6, PRAIRIE DU CHIEN, W 08/01/015 07/1/016 VERNON MEMORIAL HOSPITAL 507 S. MAIN STREET VIROQUA, WI Vernon County Surveyor: Roderic Senn Lic #: 196 SUE SULLIVAN Initial Cert: 0/01/1978 [email protected] Phone: (608) /01/014 08/1/016 Fax: (608) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS /01/014 08/1/016 09/9/015 age 11 of 1

114 Vilas County FAMILY RESOURCE CENTER 5 PEACE PIPE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong Lic #: 15 DENISE WILDCAT Initial Cert: 09/01/1988 [email protected] Phone: (715) /01/015 10/1/015 Fax: (715) /01/015 10/1/015 09/01/015 10/1/015 1 DOMESTIC ABUSE PROGRAM, 157 CEDAR AVENUE, LAC DU FLAMBEAU, WI /06/016 10/1/015 1 SOBER HOME - MEN'S, 119 ARNOLD STOCK ROAD, LAC DU FLAMBEAU, WI /06/016 10/1/015 1 SOBER HOME - WOMEN'S, 55 BOBIDOSH POINT LANE, LAC DU FLAMBEAU, WI /06/016 10/1/015 LAC DU FLAMBEAU PUBLIC SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI 5458 LAKELAND UNION HIGH SCHOOL, 957 STATE HWY 70, MINOCQUA, WI /01/015 10/1/015 09/01/015 10/1/015 LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS Lic #: OLD ABE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong RYAN CHAMPAGNE Initial Cert: 0/01/015 [email protected] Phone: (715) /01/015 01/1/016 Fax: (715) CCS REGIONAL MODEL POPULATION-BASED DHS 6 0/01/015 01/1/016 09/9/015 age 114 of 1

115 Walworth County CREDENCE THERAPY ASSOCIATES 1-1/ W. GENEVA STREET ELKHORN, WI 511 Walworth County Surveyor: William Rohner Lic #: 16 KIM STEEN Initial Cert: 1/19/1995 Phone: (6) /01/014 11/0/016 Fax: (6) /01/014 11/0/016 1/01/014 11/0/016 1 CREDENCE THERAPY ASSOCIATES, 066 WEST MAIN ST UNIT #106, EAST TROY, WI 510 1/01/014 11/0/016 BADGER HIGH SCHOOL, 0 E. SOUTH STREET, LAKE GENEVA, WI 5147 BIG FOOT HIGH SCHOOL, 401 DEVILS LANE PO BOX 99, WALWORTH, WI 5184 DELAVAN-DARIEN HIGH SCHOOL, 150 CUMMINGS ST, DELAVAN, WI 5115 ELKHORN AREA HIGH SCHOOL, 48 EAST GENEVA STREET, ELKHORN, WI 511 ELKHORN AREA MIDDLE SCHOOL, 67 EAST COURT ST., ELKHORN, WI 511 JACKSON ELEMENTARY SCHOOL, 1 NORTH JACKSON STREET, ELKHORN, WI 511 LAKE GENEVA MIDDLE SCHOOL, 600 BLOOMFIELD ROAD, LAKE GENEVA, WI 5147 SHARON COMMUNITY SCHOOL, 104 E. SCHOOL ST, SHARON, WI 5585 TIBBETS ELEMENTARY SCHOOL, W518 COUNTY ROAD A, ELKHORN, WI 511 WEST SIDE ELEMENTARY SCHOOL, SUNSET DRIVE, ELKHORN, WI /14/016 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 06/0/015 11/0/016 06/0/015 11/0/016 06/0/015 11/0/016 09/14/016 11/0/016 0/09/015 11/0/016 06/0/015 11/0/016 06/0/015 11/0/016 GENESIS BEHAVIORAL SERVICES INC. ELKHORN OUTPATIENT Lic #: 97 0 SOUTH COUNTY RD H UNIT B ELKHORN, WI 511 Walworth County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 09/04/01 [email protected] Phone: (6) /01/015 08/1/016 Fax: (6) /01/015 08/1/016 WALWORTH COUNTY DHHS COMPREHENSIVE COMMUNITY SERVICES Lic #: 889 W4051 COUNTY ROAD NN ELKHORN, WI 511 Walworth County Surveyor: William Rohner LISA KADLEC Initial Cert: 01/0/010 [email protected] Phone: (6) /01/015 01/1/017 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 01/1/017 09/9/015 age 115 of 1

116 WALWORTH COUNTY HEALTH AND HUMAN SERVICES Lic #: 1967 W4051 COUNTY TRUNK NN ELKHORN, WI 511 Walworth County Surveyor: William Rohner CARLO NEVICOSI Initial Cert: 10/01/1975 Phone: (6) /01/014 08/1/016 Fax: (6) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 Washburn County ACCESS, INC HWY 6 SOUTH SPOONER, WI Washburn County Surveyor: Polly Wong Lic #: 61 ANDREW WOLF Initial Cert: 01/01/006 [email protected] Phone: (715) /01/014 1/1/015 Fax: (715) CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 01/01/014 1/1/015 08/01/014 1/1/015 01/01/014 1/1/015 08/01/014 1/1/015 1 ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 10 ARLEN CT, EAU CLAIRE, WI /01/014 1/1/015 1 ACCESS, INC, 100 POLK COUNTY PLAZA, #70, BALSAM LAKE, WI /01/014 1/1/015 1 ACCESS, INC, 0 E LASALLE STREET, BARRON, WI /01/014 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 915 INDIANHEAD DR., MOSINEE, WI /01/014 10/01/014 ACCESS, INC - LADYSMITH, 108 W. ND STREET N, LADYSMITH, WI ACCESS, INC - LADYSMITH, 804 W 9TH STREET N, SUITE B, LADYSMITH, WI ACCESS, INC DBA AURORA COMMUNITY COUNSELING, 406 TECHNOLOGY DR. E SUITE C, MENOMON ACCESS, INC. - SIREN, 4670 STATE ROAD 5/70, #100, SIREN, WI 5487 ACCESS INC SPOONER-MIDDLE/HIGH SCHOOL, 500 COLLEGE AVE., SPOONER, WI ACCESS INC-LADYSMITH ELEMENTARY SCHOOL, 64 EAST 6TH STREET, LADYSMITH, WI ACCESS, INC - SPOONER MIDDLE SCHOOL, 750 OAK STREET, SPOONER, WI ACCESS, INC-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET SOUTH, LADYSMITH, WI ACCESS, INC-SCHOOL DISTRICT OF FLAMBEAU, N 4540 CTY HWY I, TONY, WI 5456 GRANTSBURG MIDDLE/SENIOR HIGH SCHOOL, 480 EAST JAMES AVENUE, GRANTSBURG, WI /0/015 1/1/015 08/01/014 08/0/015 08/01/014 1/1/015 08/01/014 1/1/015 01/01/014 05/1/014 08/01/014 1/1/015 06/01/014 1/1/015 08/01/014 1/1/015 08/01/014 1/1/015 08/01/014 1/1/015 09/9/015 age 116 of 1

117 Washington County GENESIS BEHAVIORAL SERVICES HARTFORD OUTPATIENT CLINIC Lic #: E. SUMNER STREET HARTFORD, WI 507 Washington County GINA SINGLETERY Initial Cert: 04/01/1994 Phone: (6) /01/014 0/1/016 Fax: (6) /01/014 0/1/016 04/01/014 0/1/016 ELEVATE, INC. N169 W1005 MEADOW LANE JACKSON, WI 507 Washington County Lic #: 14 MARY SIMON Initial Cert: 0/01/1990 Phone: (6) /01/015 0/8/017 Fax: (6) CSAS-INTERVENTION DHS CSAS-PREVENTION DHS /01/015 0/8/017 0/01/015 0/8/017 AFFILIATED CLINICAL SERVICES INC 111 E WASHINGTON STREET WEST BEND, WI 5095 Washington County Lic #: 1017 DEBRA PIETSCH Initial Cert: 10/01/1984 [email protected] Phone: (6) /01/015 06/0/016 Fax: (6) /01/015 06/0/016 06/01/015 06/0/016 AFFILIATED CLINICAL SERVICES INC, 8 SELL DRIVE #B, HARTFORD, WI /01/015 06/0/016 WEST BEND EAST & WEST HIGH SCHOOL, 105 E. DECORAH RD., RM N 15, WEST BEND, WI /01/015 06/0/016 AFFILIATED CLINICAL SERVICES, INC. 111 EAST WASHINGTON STREET WEST BEND, WI 5095 Washington County Lic #: 851 DEBRA PIETSCH Initial Cert: 0/01/009 [email protected] Phone: (6) /01/015 0/9/016 Fax: (6) CSAS-DAY TREATMENT DHS /01/015 0/9/016 09/9/015 age 117 of 1

118 CALM HARBOR 141 SOUTH 8TH AVE WEST BEND, WI 5095 Washington County Lic #: 641 MARY SIMON Initial Cert: 0/01/006 Phone: (6) /01/015 0/8/017 Fax: (6) CSAS-RESIDENTIAL INTOXICATION MONITORING DHS /01/015 0/8/017 GENESIS BEHAVIORAL SERVICES, INC. WEST BEND OUTPATIENT CLINIC Lic #: CLARENCE COURT WEST BEND, WI 5095 Washington County GINA SINGLETERY Initial Cert: 01/01/1987 Phone: (414) /01/014 1/1/015 Fax: (414) CSAS-DAY TREATMENT DHS /01/014 1/1/015 01/01/014 1/1/015 01/01/014 1/1/015 1 GENESIS BEHAVIORAL SERVICES, INC, W175 N1116 STONEWOOD DRIVE, #08, GERMANTOWN, WI 01/01/014 1/1/015 WASHINGTON COUNTY MENTAL HEALTH CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: 580 E WASHINGTON STREET, #100 WEST BEND, WI 5095 Washington County ERIC DIAMOND Initial Cert: 0/01/005 [email protected] Phone: (6) /01/014 0/9/016 Fax: (6) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 01/01/015 0/9/016 0/01/014 1/1/014 09/9/015 age 118 of 1

119 Waukesha County CORNERSTONE COUNSELING SERVICES, INC W. BLUEMOUND ROAD, #00 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 17 SANDRA ADAMS Initial Cert: 0/01/199 Phone: (6) /01/014 0/9/016 Fax: (6) /01/014 0/9/016 0/01/014 0/9/016 1 CORNERSTONE COUNSELING SERVICES, INC., 10 S MAIN STREET, #10, JEFFERSON, WI /01/014 0/9/016 CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 50, MILWAUKEE, WI CORNERSTONE COUNSELING SERVICES, INC., W PARK PLACE, #100, MILWAUKEE, WI 54 CORNERSTONE COUNSELING SERVICES, INC., 10 CORPORATE CENTER DRIVE, SUITE 100, OCON CORNERSTONE COUNSELING SERVICES, INC., 79 S 17TH AVENUE, #10, WEST BEND, WI 5095 CORNERSTONE COUNSELING SERVICES, INC., 400 BAY VIEW ROAD, SUITE C, MUKWONAGO, WI 51 CORNERSTONE COUNSELING SERVICES, INC., 4811 S 76TH STREET, GREENFIELD, WI 50 CORNERSTONE COUNSELING SERVICES, INC., 5555 N PORT WASHINGTON ROAD, #00, GLENDALE, CORNERSTONE COUNSELING SERVICES, INC., 741 N GRAND AVENUE, #0, WAUKESHA, WI 5186 CORNERSTONE COUNSELING SERVICES, INC., 888 THACKERAY TRAIL, #105, OCONOMOWOC, WI 5 01/01/015 0/9/016 0/01/014 0/9/016 09/9/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 0/9/016 0/01/014 09/9/014 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. JOSEPH HOSPITAL II Lic #: W CAPITOL DR ND FLOOR BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner CAROL HESS Initial Cert: 07//005 [email protected] Phone: (414) /01/015 08/1/017 Fax: (414) /01/015 08/1/017 09/01/015 08/1/017 1 WHEATON FRANCISCAN BEHAVIORAL HEALTH, 19 CAPITOL DRIVE, PEWAUKEE, WI /01/015 08/1/017 ALLIANCE COUNSELING CENTER 155 E CAPITOL DRIVE, SUITE 6A HARTLAND, WI 509 Waukesha County Surveyor: William Rohner Lic #: 14 BARBARA BINDER Initial Cert: 08/06/1999 [email protected] Phone: (6) /8/015 01/1/017 Fax: (6) /8/015 01/1/017 1 ALLIANCE COUNSELING CENTER, 1 N GRANDVIEW BOULEVARD, #10, WAUKESHA, WI /8/015 01/1/017 1 ALLIANCE COUNSELING CENTER, N91 W17194 APPLETON AVE, #105, MENOMONEE FALLS, WI /8/015 01/1/017 09/9/015 age 119 of 1

120 FROEDTERT & THE MEDICAL COLLEGE OF WI-COMMUNITY MEMORIAL HOSPITAL Lic #: 076 W180 N8085 TOWN HALL ROAD MENOMONEE FALLS, WI 5051 Waukesha County Surveyor: William Rohner LYNN DUNN Initial Cert: 10/01/198 Phone: (6) /01/014 08/1/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 09/01/014 08/1/016 ROGERS MEMORIAL HOSPITAL 4700 VALLEY ROAD OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner Lic #: 1810 KATHY LOTZ Initial Cert: 08/01/1988 Phone: (6) /01/01 10/1/015 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-DAY TREAT/CHLDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS MENTAL HEALTH-INPATIENT DHS /01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 ROGERS MEMORIAL HOSPITAL - HERRINGTON RECOVERY CENTER Lic #: VALLEY ROAD OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner CINDY SUSZEK Initial Cert: 06/01/1998 [email protected] Phone: (6) /01/015 05/1/017 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 05/1/017 06/01/015 05/1/017 LAKE COUNTRY WELLNESS AND COUNSELING 85 FOREST GROVE DRIVE, #10 PEWAUKEE, WI 507 Waukesha County Surveyor: William Rohner Lic #: 798 DIANE GARRISON, PHD Initial Cert: 08/1/008 [email protected] Phone: (6) /01/014 08/1/016 Fax: (6) /01/014 08/1/016 09/9/015 age 10 of 1

121 ROSECRANCE INC N7 W957 PAUL ROAD STE 101 PEWAUKEE, WI 507 Waukesha County Surveyor: William Rohner Lic #: 987 MELANIE LINDBLADE Initial Cert: 01/16/01 Phone: (815) /01/014 01/1/016 Fax: (815) /01/014 01/1/016 QUAD/MED, LLC, SUBSTANCE ABUSE COUNSELING SERVICES Lic #: 1768 W7 N610 SUSSEX ROAD SUSSEX, WI 5089 Waukesha County Surveyor: William Rohner CARRIE KELSEY Initial Cert: 1/01/1995 Phone: (414) /01/01 11/0/015 Fax: (414) /01/01 11/0/015 1 QUAD/GRAPHICS, 1900 W SUMMER STREET, HARTFORD, WI 507 1/01/01 11/0/015 1 QUAD/GRAPHICS, 555 S 108TH STREET, MILWAUKEE, WI 514 1/01/01 11/0/015 1 QUAD/GRAPHICS, N11896 HWY 175, PO BOX 718, LOMIRA, WI /01/01 11/0/015 1 QUAD/GRAPHICS, N6 W075 HWY 74, SUSSEX, WI /01/01 11/0/015 ACS CLINICAL SERVICES LLC - WAUKESHA 17 WISCONSIN AVE SUITE 09 WAUKESHA, WI 5187 Waukesha County Surveyor: William Rohner Lic #: 99 AMY SCHABEL Initial Cert: 0/01/01 [email protected] Phone: (6) /9/015 0/9/016 Fax: (6) ACS CLINICAL SERVICES, LLC - BEAVER DAM, 0 SEIPPEL BLVD., BEAVER DAM, WI /9/015 0/9/016 08/9/015 0/9/016 ACS CLINICAL SERVICE, LLC - MILWAUKEE BRANCH, 66 N PROSPECT AVE SUITES 04 & 50, MILW ACS CLINICAL SERVICES, LLC - MADISON, 7017 RAYWOOD ROAD, MADISON, WI /9/015 0/9/016 08/9/015 0/9/016 ADDICTION RESOURCE COUNCIL, INC. 741 N GRAND AVE, SUITE 00 WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner Lic #: 58 JOSEPH A. MUCHKA Initial Cert: 07/6/000 [email protected] Phone: (6) /01/015 06/0/017 Fax: (6) CSAS-INTERVENTION DHS CSAS-PREVENTION DHS /01/015 06/0/017 07/01/015 06/0/017 09/9/015 age 11 of 1

122 AURORA BEHAVIORAL HEALTH CENTER - WAUKESHA Lic #: 86 W1 N1440 HWY. CORPORATE CT #10 WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner KATE CONNELLY Initial Cert: 04/01/00 [email protected] Phone: (414) /01/014 04/0/016 Fax: (414) /01/014 04/0/016 05/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER - BROOKFIELD, WEST BLUEMOUND ROAD, BROOKFIE 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, W NATIONAL AVE, NEW BERLIN, WI 51 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-WAUKESHA, 6500 AURORA DRIVE, SUMMIT, WI /01/014 04/0/016 GENESIS HOUSE - LUTHERAN SOCIAL SERVICES Lic #: MOTOR AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner JAMES AKER Initial Cert: 07/01/1994 [email protected] Phone: (6) /01/014 06/0/016 Fax: (6) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 06/0/016 07/01/014 06/0/016 HORIZON HEALTHCARE, INC. 17 WISCONSIN AVE STE #11 WAUKESHA, WI 5186 Waukesha County Surveyor: William Rohner Lic #: 1058 EMILY HILL Initial Cert: 08/01/199 [email protected] Phone: (414) /01/014 07/1/016 Fax: (414) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 09/9/015 age 1 of 1

123 PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES Lic #: AMERICAN AVENUE #501 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner O. KIRK YAUCHLER Initial Cert: 06/01/1986 Phone: (6) /01/015 1/1/015 Fax: (6) /01/015 1/1/015 10/01/015 1/1/015 1 PROHEALTH CARE SLEEP CENTER, 01 SUN VALLEY DRIVE #00, DELAFIELD, WI /01/015 1/1/015 1 WAUKESHA HEALTH SYS DBA BMC, 10 BIG BEND ROAD, WAUKESHA, WI /01/015 1/1/015 WAUKESHA HEALTH SYS DBA PHCMA - WATERTOWN, 109 AIR PARK DR., WATERTOWN, WI 5 WAUKESHA HEALTH SYS DBA PHCMA PEWAUKEE, N16W411 RIVERWOOD DR., WAUKESHA WAUKESHA HEALTH SYS DBA PHCMA SUSSEX, N57 W4950 N CORPORATE CIRCLE, SUSSEX WAUKESHA HEALTH SYS DBA BMC, 1185 CORPORATE CENTER DR SUITE 0, OCONOMOWOC, WI 5 WAUKESHA HEALTH SYS DBA BMC, 1900 WEST NATIONAL AVE, NEW BERLIN, WI 5151 WAUKESHA HEALTH SYS DBA BMC, 1500 WALNUT RIDGE DR, HARTLAND, WI 509 WAUKESHA HEALTH SYS DBA BMC, 085 NORTH CALHOUN RD, BROOKFIELD, WI 5005 WAUKESHA HEALTH SYS DBA BMC, 40 WEST MAPLE AVE, MUKWONAGO, WI 5149 WAUKESHA HEALTH SYS DBA BMC, S69 W1566 JANESVILLE RD, MUSKEGO, WI 5150 WAUKSHA HEALTH SYS DBA BMC@PHCMA MORELAN, 717 WEST MORELAND BLVD, WAUKESHA, WI 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 10/01/015 1/1/015 QAM-QUALITY ADDICTION MANAGEMENT 4 N. GRANDVIEW BOULEVARD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1748 WENDY KOHLHAAS Initial Cert: 04/01/1994 [email protected] Phone: (6) /01/015 08/1/017 Fax: (6) CSAS-NARCOTIC TREATMENT DHS /01/015 08/1/017 09/01/015 08/1/017 SIXTEENTH STREET COMMUNITY HEALTH CENTERS DBA WAUKESHA COMMUNITY HEALTH CENTER Lic #: EAST NORTH STREET WAUKESHA, WI 5186 Waukesha County MARIA ELENA PEREZ, PHD Initial Cert: 04/01/014 [email protected] Phone: (6) /01/015 0/1/017 Fax: (414) /01/015 0/1/017 WAUKESHA COUNTY DHHS CCS 1501 AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 04 DANIELLE BIRDEAU Initial Cert: 07/01/014 [email protected] Phone: (6) /01/014 06/0/016 Fax: (6) CCS REGIONAL MODEL POPULATION-BASED DHS 6 07/01/014 06/0/016 1 WAUKESHA CO DHHS HUMAN SERVICES CENTER, 514 RIVERVIEW AVE, WAUKESHA, WI /01/014 06/0/016 09/9/015 age 1 of 1

124 WAUKESHA COUNTY MENTAL HEALTH CENTER 514 RIVERVIEW AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1970 GORDON OWLEY, PHD Initial Cert: 04/01/1984 Phone: (6) /01/015 04/0/017 Fax: (6) MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 WAUKESHA COUNTY MENTAL HEALTH CENTER, 1501 AIRPORT RD, WAUKESHA, WI /01/015 04/0/017 WAUKESHA COUNTY MENTAL HEALTH CENTER 1501 AIRPORT ROAD WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1971 JEFFRY LEWIS Initial Cert: 04/01/1987 Phone: (6) /01/014 04/0/016 Fax: (6) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 WAUKESHA MEMORIAL HOSPITAL 75 AMERICAN AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner Lic #: 1976 CORRINE GRESEN Initial Cert: 06/01/1986 Phone: (6) /01/015 1/1/016 Fax: (6) CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS MENTAL HEALTH-DAY TREATMENT DHS MENTAL HEALTH-INPATIENT DHS /01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 09/9/015 age 14 of 1

125 Waupaca County MINISTRY BEHAVIORAL HEALTH 190 GRAND SEASONS DRIVE WAUPACA, WI Waupaca County Surveyor: Hannah Whaley Lic #: 645 TERESA TAYLOR Initial Cert: 0/01/006 Phone: (715) /01/014 01/1/016 Fax: (715) /01/014 01/1/016 0/01/014 01/1/016 WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: HARDING STREET WAUPACA, WI Waupaca County Surveyor: Hannah Whaley CHUCK PRICE Initial Cert: 1/01/1981 Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-EMERGENCY OUTPATIENT DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 WAUPACA CO DEPT OF HEALTH & HUMAN SERV, 1405 MILL ST, NEW LONDON, WI /01/014 06/0/016 09/9/015 age 15 of 1

126 Waushara County ALL AREA COUNSELING SERVICES-A DIVISION OF OPTIONS TREATMENT PROGRAMS INC Lic #: W MAIN STREET WAUTOMA, WI 5498 Waushara County Surveyor: Hannah Whaley KIMEKO HAGEN Initial Cert: 04/01/004 [email protected] Phone: (90) /01/014 0/1/016 Fax: (90) /01/014 0/1/016 04/01/014 0/1/016 1 INTEGRATIVE PAIN MANAGEMENT SC, 555 S WASHBURN ST #A, OSHKOSH, WI /01/014 08/5/014 OPTIONS TREATMENT PROGRAMS, INC., 1000 N. LYNNDALE DRIVE STE C, APPLETON, WI OPTIONS TREATMENT PROGRAMS, INC., 44 S MONROE AVE #01, GREEN BAY, WI 5401 OPTIONS TREATMENT PROGRAMS, INC., 9 CHURCHILL ST, WAUPACA, WI OPTIONS TREATMENT PROGRAMS-OSHKOSH, 50 E. NEW YORK AVE., OSHKOSH, WI /01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 04/01/014 0/1/016 WAUSHARA COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: W. PARK STREET WAUTOMA, WI 5498 Waushara County Surveyor: Erin Taylor TONI MORGAN JONES Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-PREVENTION DHS MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 BERLIN HIGH SCHOOL, MEMORIAL DRIVE, BERLIN, WI /01/014 10/1/016 TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI /01/014 10/1/016 WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI /01/014 10/1/016 WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI /01/014 10/1/016 WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI /01/014 10/1/016 WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: W PARK STREET WAUTOMA, WI 5498 Waushara County Surveyor: Erin Taylor RENEE SOROKO Initial Cert: 10/19/005 [email protected]. Phone: (90) /01/014 10/1/016 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 11/01/014 10/1/016 09/9/015 age 16 of 1

127 Winnebago County HUMAN RESOURCE ASSISTANCE CENTER, LLC 1478 KENWOOD DRIVE, D1 MENASHA, WI 5495 Winnebago County Lic #: 995 JONATHAN DORN Initial Cert: 04/01/01 Phone: (90) /01/015 0/1/017 Fax: (90) /01/015 0/1/017 THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY Lic #: KENWOOD DRIVE SUITE 1 MENASHA, WI 5495 Winnebago County ROSANGELA BERBERT Initial Cert: 0/01/198 [email protected] Phone: (90) /01/015 0/8/017 Fax: (90) /01/015 0/8/017 0/01/015 0/8/017 1 PROJECT OPEN DOOR IMMANUEL UNITED CHURCH, 510 SULLIVAN AVENUE, KAUKAUNA, WI /01/015 0/8/017 1 THE SAMARITAN COUNSELING CENTER OF FV AT LHCC, 510 DOCTORS COURT, OSHKOSH, WI /19/016 0/8/017 1 THE SAMARITAN COUNSELING CTR FOX VALLEY, 1478 MIDWAY ROAD, MENASHA, WI /01/015 0/8/017 THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI /01/015 0/8/017 0/01/015 0/8/017 THEDACARE BEHAVIORAL HEALTH 1095 MIDWAY ROAD MENASHA, WI 5495 Winnebago County Lic #: 05 JEAN DEKEYSER, RN, MS Initial Cert: 07/1/1998 [email protected] Phone: (90) /01/014 06/0/016 Fax: (90) CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI /01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI THEDACARE BEHAVIORAL HEALTH, 1818 NORTH MEADE STREET, APPLETON, WI THEDACARE BEHAVIORAL HEALTH, 500 E CAPITAL DRIVE, APPLETON, WI THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI THEDACARE BEHAVIORAL HEALTH, 90 RIVERSIDE DRIVE, #04, WAUPACA, WI /01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 09/9/015 age 17 of 1

128 ESPRIT COUNSELING AND CONSULTING 40 JEWELERS PARK DRIVE NEENAH, WI Winnebago County Lic #: 968 KERRIE JO LARSON Initial Cert: 07/6/01 Phone: (90) /01/014 06/0/016 Fax: (90) /01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH AT THEDA CLARK MEDICAL CENTER Lic #: SECOND STREET NEENAH, WI Winnebago County COLLETTE HARTFIEL Initial Cert: 0/01/198 Phone: (90) /01/015 01/1/017 Fax: (90) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 01/1/017 0/01/015 01/1/017 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: N COMMERCIAL STREET NEENAH, WI Winnebago County MICHAEL DAEHN PHD Initial Cert: 07/01/1988 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) /01/014 10/1/016 11/01/014 10/1/016 AMS OF WISCONSIN, LLC - OSHKOSH 505 S WASHBURN STREET OSHKOSH, WI Winnebago County Surveyor: Erin Taylor Lic #: 089 SHAREL ROGERS Initial Cert: 09/04/015 [email protected] Phone: (90) - 09/04/015 08/1/016 Fax: (90) -4 CSAS-NARCOTIC TREATMENT DHS /04/015 08/1/016 09/04/015 08/1/016 GENESIS BEHAVIORAL SVCS OSHKOSH RESIDENTIAL PROGRAM Lic #: OTTER AVENUE OSHKOSH, WI Winnebago County GINA SINGLETERY Initial Cert: 09//01 [email protected] Phone: (90) /01/015 08/1/016 Fax: (90) 5-06 CSAS-TRANSITIONAL RESIDENTIAL DHS /01/015 08/1/016 09/9/015 age 18 of 1

129 MERCY COUNSELING SERVICES 500 SOUTH OAKWOOD RD OSHKOSH, WI Winnebago County Lic #: 161 TINA LECHNIR Initial Cert: 0/01/1995 Phone: (90) /01/014 08/1/016 Fax: (90) /01/014 08/1/016 09/01/014 08/1/016 MERCY MEDICAL CENTER 500 S OAKWOOD ROAD OSHKOSH, WI Winnebago County Lic #: 1608 TINA LECHNIR Initial Cert: 0/01/198 [email protected] Phone: (90) /01/014 08/1/016 Fax: (90) -404 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/014 08/1/016 09/01/014 08/1/016 NOVA COUNSELING SERVICES, INC 40 JACKSON STREET OSHKOSH, WI Winnebago County Lic #: 1710 HUGH HOLLY Initial Cert: 11/01/1985 [email protected] Phone: (90) /01/014 04/0/016 Fax: (90) CSAS-MEDICALLY MONITORED TREATMENT DHS CSAS-TRANSITIONAL RESIDENTIAL DHS /01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN Initial Cert: 10/01/1975 [email protected] Phone: (90) /01/014 10/1/016 Fax: (90) CSAS-EMERGENCY OUTPATIENT DHS CSAS-PREVENTION DHS MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 11/01/014 10/1/016 09/9/015 age 19 of 1

130 WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN PHD Initial Cert: 0/09/005 [email protected] Phone: (90) /01/015 0/1/017 Fax: (90) CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 WINNEBAGO MENTAL HEALTH INSTITUTE TREFFERT DRIVE & BUTLER AVENUE WINNEBAGO, WI Winnebago County Lic #: 008 THOMAS SPEECH Initial Cert: 10/01/1975 Phone: (90) /01/01 10/1/015 Fax: (90) 7-04 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS CSAS-MEDICALLY MONITORED TREATMENT DHS MENTAL HEALTH-ADOLESCENT INPATIENT DHS MENTAL HEALTH-INPATIENT DHS /01/01 10/1/014 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 11/01/01 10/1/015 Winona County (MN) HIAWATHA VALLEY MENTAL HEALTH CENTER 166 MAIN STREET WINONA, MN Winona County (MN) Surveyor: Roderic Senn Lic #: 8 JULIE HANSON Initial Cert: 09/1/009 [email protected] Phone: (507) /01/014 08/1/016 Fax: (507) /01/014 08/1/016 09/01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 19 MAIN STREET, LA CROSSE, WI /01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 611 BROADWAY AVENUE, #100, WABASHA, MN /01/014 08/1/016 HIAWATHA VALLEY MENTAL HEALTH CENTER, 85 S. SERVICE DR., STE. 10, RED WING, MN HIAWATHA VALLEY MENTAL HEALTH CENTER, LA CROSSE CNTY JUVE FAC TH ST NORTH, LA C 06/05/015 08/1/016 09/01/014 08/1/016 09/9/015 age 10 of 1

131 Wood County HERGERT & ASSOCIATES FAMILY COUNSELING SERVICES Lic #: S CENTRAL AVENUE, #1 MARSHFIELD, WI Wood County Surveyor: Hannah Whaley LISA HERGERT Initial Cert: 05/08/006 [email protected] Phone: (715) /01/015 1/1/015 Fax: (715) /01/015 1/1/015 NORWOOD HEALTH CENTER 1600 N. CHESTNUT AVENUE MARSHFIELD, WI Wood County Surveyor: Erin Taylor Lic #: 1709 RHONDA KOZIK Initial Cert: 04/01/1980 [email protected] Phone: (715) /01/015 01/1/017 Fax: (715) CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS MENTAL HEALTH-INPATIENT DHS /01/015 01/1/017 0/01/015 01/1/017 OLSON PROFESSIONAL COUNSELING SERVICES LLC Lic #: S CENTRAL AVE STE 4 MARSHFIELD, WI Wood County Surveyor: Hannah Whaley JERRY OLSON Initial Cert: 01/05/015 [email protected] Phone: (715) /05/015 1/1/015 Fax: (715) /05/015 1/1/015 CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC Lic #: TH ST SOUTH STE #101 WISCONSIN RAPIDS, WI Wood County Surveyor: Erin Taylor DEB FUEHRER Initial Cert: 09/7/01 [email protected] Phone: (715) /01/015 08/1/016 Fax: (888) MENTAL HEALTH-DAY TREATMENT FOR CHILDREN 1 DHS 40.11() 09/01/015 08/1/016 09/01/015 08/1/016 09/01/015 08/1/016 CHILD & ADOLESCENT PSYCHIATRY CONSULTING, M407 STATE HWY 97, MARSHFIELD, WI /01/015 08/1/016 09/9/015 age 11 of 1

132 CLINICAL SERVICES 40-1ST AVENUE SOUTH WISCONSIN RAPIDS, WI Wood County Surveyor: Erin Taylor Lic #: 108 DR MICHAEL J NELSON Initial Cert: 10/01/1988 [email protected] Phone: (715) /01/015 09/0/017 Fax: (715) CSAS-INTERVENTION DHS /01/015 09/0/017 10/01/015 09/0/016 RIVERVIEW HOSPITAL ASSOCIATION 410 DEWEY STREET WISCONSIN RAPIDS, WI Wood County Surveyor: Hannah Whaley Lic #: 180 COLLEEN KANE Initial Cert: 07/01/1986 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS /01/014 06/0/016 WOOD COUNTY HUMAN SERVICES CCS 611-1TH AVENUE, SOUTH WISCONSIN RAPIDS, WI Wood County Surveyor: Hannah Whaley Lic #: 678 KATHY ROETTER Initial Cert: 08/01/1977 [email protected] Phone: (715) /01/014 06/0/016 Fax: (715) CCS REGIONAL MODEL SHARED SERVICES DHS 6 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 09/01/014 06/0/016 07/01/014 08/1/014 WOOD COUNTY HUMAN SERVICES DEPARTMENT Lic #: TH STREET SOUTH WISCONSIN RAPIDS, WI Wood County Surveyor: Hannah Whaley SUSAN SCHUELER-SHEVELAND Initial Cert: 08/01/1977 Phone: (715) /01/014 06/0/016 Fax: (715) CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-EMERGENCY SERVICE W/TELEHEALTH DHS 4. 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORWOOD HEALTH CARE BRANCH OFFICE, 1600 NORTH CHESTNUT, MARSHFIELD, WI /01/014 06/0/016 09/9/015 age 1 of 1