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

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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 5701-969 ADAMS COUNTY HEALTH & HUMAN SERVICES DEPT COMPREHENSIVE COMMUNITY SERVICES Lic #: 810 108 E NORTH STREET FRIENDSHIP, WI 594 Adams County Surveyor: Hannah Whaley DIANE CABLE Initial Cert: 1/10/008 diane.cable@co.adams.wi.us Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) 9-4585 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 ADAMS COUNTY HEALTH AND HUMAN SERVICES DEPARTMENT Lic #: 15 108 E NORTH STREET FRIENDSHIP, WI 594 Adams County Surveyor: Hannah Whaley DIANE CABLE Initial Cert: 09/01/1990 diane.cable@co.adams.wi.us Phone: (608) 9-4 0/01/015 0/9/016 Fax: (608) 9-4585 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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

Ashland County BAD RIVER AODA PROGRAM 5585 NOKOMIS RD ASHLAND, WI 54806 Ashland County Surveyor: Polly Wong Lic #: 78 JOANN WOODHULL Initial Cert: 0/01/007 aodacoord@badriverhealthservices Phone: (715) 68-717 0/01/015 0/8/017 Fax: (715) 685-7857 CSAS-DAY TREATMENT DHS 75.1 0/01/015 0/8/017 0/01/015 0/8/017 BEHAVIORAL HEALTH SERVICES OF MEMORIAL MEDICAL CENTER Lic #: 154 165 MAPLE LANE ASHLAND, WI 54806 Ashland County Surveyor: Polly Wong CONNIE GUDERIAN Initial Cert: 10/01/1999 cguderian@ashlandmmc.com Phone: (715) 685-5400 10/01/01 09/0/015 Fax: (715) 685-510 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 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 10/01/01 09/0/015 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI 54806 10/01/01 09/0/015 DRUMMOND AREA SCHOOL DISTRICT, 5440 EASTERN AVE, DRUMMOND, WI 548 09/18/016 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 david.hensley@co.barron.wi.us Phone: (715) 57-5691 11/01/01 10/1/015 Fax: (715) 57-6848 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. 11/01/01 10/1/015 11/01/01 10/1/015 09/9/015 Page of 1

Bayfield County RED CLIFF AODA PROGRAM/MISHOMIS HOUSE 790 N BRADUM ROAD BAYFIELD, WI 54814 Bayfield County Surveyor: Polly Wong Lic #: 1781 DR. JOSEPH CORBINE Initial Cert: 11/01/198 joseph.corbine@redcliff-nsn.gov Phone: (715) 779-741 10/01/014 09/0/016 Fax: (715) 779-765 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 10/01/014 09/0/016 10/01/014 09/0/016 NORTHLAKES COMMUNITY CLINIC - AODA SERVICES Lic #: 1064 7665 US HWY IRON RIVER, WI 54847 Bayfield County Surveyor: Polly Wong JASON AKL Initial Cert: 09/01/1984 jakl@northlakesclinic.org Phone: (715) 7-5001 10/01/014 08/1/016 Fax: (715) 7-5067 10/01/014 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 54891 10/01/015 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 54806 ASHLAND MIDDLE SCHOOL, 0-11TH STREET EAST, ASHLAND, WI 54806 BAD RIVER HEAD START, 5759 PINE STREET, ODANAH, WI 54861 LAKE SUPERIOR PRIMARY AND ELEMENTARY SCHOOLS, 1101 BINSFIELD ROAD, ASHLAND, WI 54806 10/01/015 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 #: 054 4 WEST BAYFIELD STREET WASHBURN, WI 54891 Bayfield County Surveyor: Polly Wong VAL LEVNO Initial Cert: 01/01/015 vlevno@nhnorth.com Phone: (715) 7-6144 01/01/015 1/1/015 Fax: (715) 7-610 CCS REGIONAL MODEL SHARED SERVICES DHS 6 01/01/015 1/1/015 09/9/015 Page of 1

NORTHLAND COUNSELING SERVICES 1 W OMAHA STREET WASHBURN, WI 54891 Bayfield County Surveyor: Polly Wong Lic #: 61 JEREMY KOEHL Initial Cert: 07/01/001 northland006@centurytel.net Phone: (715) 7-0160 07/01/014 06/0/016 Fax: (715) 7-016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES LTD, 117 EAST SIXTH STREET, WASHBURN, WI 54891 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 1619 WEST THIRD STREET, ASHLAND, WI 54806 07/01/014 06/0/016 1 NORTHLAND COUNSELING SERVICES, 611 E WALL STREET, EAGLE RIVER, WI 5451 07/01/014 06/0/016 09/9/015 Page 4 of 1

Brown County RIVERSIDE PSYCHIATRIC GROUP SC 15 ANGELS PATH DE PERE, WI 54115 Brown County Lic #: 64 RACHEL SCHUTT Initial Cert: 1/01/000 rachel@riversidepsych.com Phone: (90) 8-855 01/01/015 1/1/016 Fax: (90) 8-970 01/01/015 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 knelson@correctionalservices.org Phone: (90) 469-569 07/01/015 06/0/016 Fax: (90) 469-580 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/015 06/0/016 AMERICAN FOUNDATION OF COUNSELING SERVICES, INC. Lic #: 105 10 E WALNUT STREET #706 GREEN BAY, WI 5401 Brown County JILL BECK Initial Cert: 04/01/1981 jbeck@afcscounseling.org Phone: (90) 47-856 05/01/014 04/0/016 Fax: (90) 47-1188 05/01/014 04/0/016 05/01/014 04/0/016 1 GOLDEN HOUSE, 110 UNIVERSITY AVE, GREEN BAY, WI 540 05/01/014 04/0/016 1 HOUSE OF HOPE, 1660 CHRISTIANA ST., GREEN BAY, WI 540 05/01/014 04/0/016 1 MICAH CENTER, 700 E. WALNUT ST., GREEN BAY, WI 5401 01/01/015 04/0/016 1 NEW COMMUNITY CLINIC - NWTC, 740 W. MASON ST., GREEN BAY, WI 5407 01/1/015 04/0/016 1 NEW COMMUNITY CLINIC, 6 BODART ST, GREEN BAY, WI 5401 01/1/015 04/0/016 1 OUTREACH HEALTHCARE, 879 MATHER ST., GREEN BAY, WI 540 01/01/015 04/0/016 NEW COMMUNITY SHELTER, 01 MATHER ST, GREEN BAY, WI 5401 01/01/015 04/0/016 BAETEN COUNSELING & CONSULTATION TEAM, S.C Lic #: 047 90 S WEBSTER AVE, SUITE B GREEN BAY, WI 5401 Brown County TINA BAETEN Initial Cert: 08/06/014 tina@baetencounseling.com Phone: (90) 6-4471 08/01/015 07/1/017 Fax: (90) 6-415 08/01/015 07/1/017 08/01/015 07/1/017 09/9/015 Page 5 of 1

BELLIN PSYCHIATRIC CENTER 01 E ST JOSEPH STREET GREEN BAY, WI 5405 Brown County Lic #: 1098 STEVE DUSCHER Initial Cert: 04/01/1984 sldusc@bellin.org Phone: (90) 41-5687 04/01/014 0/1/016 Fax: (90) 41-0 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 04/01/014 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 5401 08/04/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER - BRILLION, 964 W. RYAN ST., STE. B, BRILLION, WI 54110 04/0/015 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 575-4TH ST, KEWAUNEE, WI 5416 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 704 S. WEBSTER STE. #01, GREEN BAY, WI 5401 04/01/014 0/1/016 1 BELLIN PSYCHIATRIC CENTER, 744 S WEBSTER AVE, GREEN BAY, WI 5401 04/01/014 0/1/016 BELLIN PSYCHIATRIC CENTER - EAST DE PERE, 555 REDBIRD CIRCLE STE 100, DE PERE, WI 54115 BELLIN PSYCHIATRIC CENTER - OCONTO FALLS, 8 MAIN STREET, OCONTOFALLS, WI 54154 BELLIN PSYCHIATRIC CENTER-NEURO TEAM, 75 S WEBSTER, GREEN BAY, WI 5405 BELLIN PSYCHIATRIC CENTER-W. DE PERE, 1800 LAWRENCE DR, DE PERE, WI 54115 DR. ROSA MINOKA-HILL SCHOOL, 5 N ROOSEVELT, GREEN BAY, WI 5401 1/0/014 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 #: 1117 150 GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 10/01/1975 agar_ij@co.brown.wi.us Phone: (90) 91-6959 09/01/015 08/1/017 Fax: (90) 91-4811 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 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 61.71 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 09/01/015 08/1/017 BROWN COUNTY HUMAN SVS YOUTH CLINIC, 111 NORTH JEFFERSON ST, GREEN BAY, WI 5405 09/01/015 08/1/017 BROWN COUNTY COMMUNITY TREATMENT CENTER COMPREHENSIVE COMMUNITY SERVICES Lic #: 615 150 GERSHWIN DRIVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 08/5/005 Agar_IJ@co.brown.wi.us Phone: (90) 91-6959 09/01/014 08/1/016 Fax: (90) 91-4811 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

BROWN COUNTY HUMAN SERVICES - DIVERSION Lic #: 96 111 DANZ AVE GREEN BAY, WI 5411 Brown County IAN AGAR Initial Cert: 0/01/011 Agar_IJ@co.brown.wi.us Phone: (90) 91-6959 0/01/014 01/1/016 Fax: (90) 448-6197 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 0/01/014 01/1/016 FAMILY SERVICES OF NORTHEAST WISCONSIN, INC. Lic #: 19 00 CROOKS STREET GREEN BAY, WI 5401 Brown County LOIS MISCHLER Initial Cert: 01/1/1996 lmischler@familyservicesnew.org Phone: (90) 46-6800 04/01/014 0/1/016 Fax: (90) 4-5966 04/01/014 0/1/016 04/01/014 0/1/016 1 BILLIE KRESS CENTER - YOUTH DEVELOPMENT, 40 SPIRIT WAY, GREEN BAY, WI 5404 04/01/014 0/1/016 1 FAMILY SERVICES - SOUTH IRWIN, 66 S IRWIN AVENUE, GREEN BAY, WI 5401 04/0/014 0/1/016 1 WILLOW TREE, 50 S MONROE STREET, GREEN BAY, WI 5401 04/0/014 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 #: 1 145 W MASON STREET, #01 GREEN BAY, WI 540 Brown County KENNETH SANN Initial Cert: 06//001 Ks.iacs@tds.net Phone: (90) 48-8141 07/01/014 06/0/016 Fax: (90) 48-799 07/01/014 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 wlabine@jackienitschkecenter.com Phone: (90) 45-09 01/01/015 1/1/016 Fax: (90) 45-580 01/01/015 1/1/016 09/9/015 Page 7 of 1

JACKIE NITSCHKE CENTER, INC. 60 CHERRY STREET GREEN BAY, WI 5401 Brown County Lic #: 1446 WILLIAM LABINE Initial Cert: 06/05/1990 wlabine@jackienitschkecenter.com Phone: (90) 45-09 01/01/015 1/1/016 Fax: (90) 45-580 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 01/01/015 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 mkriesch@oneidanation.org Phone: (90) 490-790 0/01/015 01/1/017 Fax: (90) 490-88 0/01/015 01/1/017 0/01/015 01/1/017 1 ONEIDA COMMUNITY HEALTH CENTER, 55 AIRPORT DRIVE, ONEIDA, WI 54155 0/01/015 01/1/017 1 ONEIDA NATION VETERAN'S DEPARTMENT, 14 RIVERDALE DR., ONEIDA, WI 54155 0/01/015 01/1/017 ONEIDA NATION ELEMENTARY SCHOOL, N715 SEMINARY ROAD, ONEIDA, WI 54155 ONEIDA NATION HIGH SCHOOL, N710 SEMINARY ROAD, ONEIDA, WI 54155 0/01/015 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 pattynewwellnessassoc@gmail.com Phone: (90) 497-600 06/01/014 05/1/016 Fax: (90) 497-15 06/01/014 05/1/016 06/01/014 05/1/016 1 NEW WELLNESS ASSOCIATES INC, 40 CROOKS AVENUE, KAUKAUNA, WI 5410 06/01/014 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 cschrauth@qam-inc.com Phone: (90) 7-6740 11/01/014 10/1/016 Fax: (90) 7-6741 CSAS-NARCOTIC TREATMENT DHS 75.15 11/01/014 10/1/016 11/01/014 10/1/016 09/9/015 Page 8 of 1

ST. JOSEPH'S HOSPITAL - HOSPITAL SISTERS -THIRD ORDER OF ST FRANCIS DBA LIBERTAS Lic #: 1505 1701 DOUSMAN STREET GREEN BAY, WI 540 Brown County BARBARA CONIFF Initial Cert: 09/01/1986 barbara.coniff@hshs.org Phone: (90) 498-8600 04/01/015 0/1/017 Fax: (90) 496-07 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 04/01/015 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 #: 17 4404 STATE RD 70 WEBSTER, WI 5489 Burnett County Surveyor: Polly Wong SARAH CORMELL Initial Cert: 05/01/000 sarahc@stcroixtribalcenter.com Phone: (715) 49-8554 05/01/014 04/0/016 Fax: (715) 49-858 05/01/014 04/0/016 05/01/014 04/0/016 1 ROUND LAKE CLINIC, 0-60TH AVENUE, LUCK, WI 5485 05/01/014 04/0/016 09/9/015 Page 9 of 1

Calumet County CALUMET COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 110 06 COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 10/01/1975 Kral.Jeremy@co.calumet.wi.us Phone: (90) 849-1400 07/01/014 06/0/016 Fax: (90) 849-1468 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54915 07/01/014 06/0/016 CALUMET COUNTY DEPT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 674 06 COURT STREET CHILTON, WI 5014 Calumet County JEREMY KRAL Initial Cert: 06/1/006 Kral.Jeremy@co.calumet.wi.us Phone: (90) 849-1400 07/01/015 06/0/017 Fax: (90) 849-1468 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

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 Margaret.Behnke@lsswis.org Phone: (715) 76-90 0/01/015 0/8/017 Fax: (715) 76-9055 0/01/015 0/8/017 1 CHIPPEWA AREA RECOVERY RESOURCE, 1 S BARSTOW ST SUITE #1, EAU CLAIRE, WI 54701 0/01/015 0/8/017 COMMUNITY COUNSELING SERVICES 16947 COUNTY HIGHWAY X CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn Lic #: 744 ARLENE ESLINGER Initial Cert: 08/14/007 arleneeslinger@sbcglobal.net Phone: (715) 7-11 08/01/014 07/1/016 Fax: (715) 78-114 CSAS-INTERVENTION DHS 75.16 08/01/014 07/1/016 ST. JOSEPH'S HOSPITAL OF THE HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Lic #: 1475 661 COUNTY HIGHWAY I CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn THERESA MACKEY Initial Cert: 01/1/1977 theresa.mackey@hshs.org Phone: (715) 7-5585 0/01/014 01/1/016 Fax: (715) 717-7504 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 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

WESTERN REGION RECOVERY AND WELLNESS CONSORTIUM-CCS Lic #: 065 711 N BRIDGE STREET CHIPPEWA FALLS, WI 5479 Chippewa County Surveyor: Roderic Senn JILL CHAFFEE Initial Cert: 04/01/015 jchaffee@co.chippewa.wi.us Phone: (715) 76-7788 04/01/015 0/1/016 Fax: (715) 76-776 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 54610 04/01/015 0/1/016 1 PEPIN COUNTY DEPT OF HUMAN SERVICES, 740-7TH AVE. WEST, DURAND, WI 5476 04/01/015 0/1/016 1 RUSK COUNTY DEPT. OF HEALTH & HUMAN SERVICES, 11 E. MINER STREET, LADYSMITH, WI 54848 04/01/015 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 54751 DUNN COUNTY DEPT OF HUMAN SERVICES, 808 MAIN STREET, MENOMONIE, WI 54751 PIERCE COUNTY DEPT OF HUMAN SERVICES, 41 W. KINNE STREET, ELLSWORTH, WI 54011 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 shesseltine@hazeldenbettyford.org Phone: (651) 1-4809 05/01/015 04/0/017 Fax: (651) 1-4551 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/015 04/0/017 05/01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 1 of 1

Clark County CLARK COUNTY COMMUNITY SERVICES 517 COURT STREET RM 50 NEILLSVILLE, WI 54456 Clark County Surveyor: Roderic Senn Lic #: 101 RUSSELL GIRARD Initial Cert: 01/01/1984 russell.girard@co.clark.wi.us Phone: (715) 74-508 01/01/014 1/1/015 Fax: (715) 74-509 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 54460 01/01/014 1/1/015 GRANTON SCHOOL DISTRICT, 17 N. MAIN STREET, GRANTON, WI 5446 NEILLSVILLE ELEMENTARY SCHOOL, 405 EAST 5TH STREET, NEILLSVILLE, WI 54456 NEILLSVILLE MIDDLE/HIGH SCHOOL, 401 CENTER STREET, NEILLSVILLE, WI 54456 08/10/015 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 54456 Clark County Surveyor: Roderic Senn Lic #: 09 SUE VOIGT Initial Cert: 09/01/015 sue.voigt@co.clark.wi.us Phone: (715) 74-508 09/01/015 08/1/016 Fax: (715) 74-509 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

Columbia County COLUMBIA COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: 898 65 MURPHY ROAD PORTAGE, WI 5901 Columbia County Surveyor: Erin Taylor DAWN WOODARD Initial Cert: 04/01/010 dawn.woodard@co.columbia.wi.us Phone: (608) 74-9717 04/01/015 0/1/017 Fax: (608) 74-9700 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 COMMUNITY SERVICES ASSOCIATES DBA PAUQUETTE CTR FOR PSYCHOLOGICAL SVCS Lic #: 149 901 HUNTERS TRAIL PORTAGE, WI 5901 Columbia County Surveyor: Hannah Whaley DR. JOCELYN MILLER PHD Initial Cert: 10/08/1999 jmiller@pauquette.com Phone: (608) 74-5518 07/01/015 06/0/016 Fax: (608) 74-4087 07/01/015 06/0/016 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 100 LINCOLN AVE, BARABOO, WI 591 07/01/015 06/0/016 COMMUNITY SERV ASSOC DBA PAUQUETTE CTR, 19 PARK AVENUE, COLUMBUS, WI 595 07/01/015 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 5578 07/01/015 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 #: 169 11 S. PRAIRIE STREET PRAIRIE DU CHIEN, WI 581 Crawford County Surveyor: Cynthia Lindgren MS LACIE ANTHONY Initial Cert: 01/01/1987 Anthony.Lacie@mayo.edu Phone: (608) 6-844 04/01/015 0/1/017 Fax: (608) 6-868 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 04/01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 14 of 1

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 lvantol@arccommserv.com Phone: (608) -90 08/01/015 07/1/017 Fax: (608) -8107 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/015 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 lauraf@arccommserv.com Phone: (608) 8-646 0/01/015 0/8/017 Fax: (608) 8-674 CSAS-DAY TREATMENT DHS 75.1 0/01/015 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 5590 0/01/015 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 cmiller@arccommserv.com Phone: (608) 8-640 1/01/01 11/0/015 Fax: (608) 8-64 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 1/01/01 11/0/015 ATTIC CORRECTIONAL SERVICES, INC. ACS CLINICAL SERVICES Lic #: 1076 1709 S. PARK STREET SUITE 1 MADISON, WI 571 Dane County Surveyor: Erin Taylor TIFFANY WALKER Initial Cert: 0/5/010 twalker@correctionalservices.org Phone: (608) 55-007 04/01/015 0/1/017 Fax: (608) 55-4005 CSAS-INTERVENTION DHS 75.16 04/01/015 0/1/017 09/9/015 Page 15 of 1

CONNECTIONS COUNSELING 5005 UNIVERSITY AVE STE #100 MADISON, WI 5705 Dane County Surveyor: Erin Taylor Lic #: 407 SHELLY DUTCH Initial Cert: 01/01/00 shelly.dutch@connectionscounselin Phone: (608) -100 04/01/015 0/1/017 Fax: (608) -101 04/01/015 0/1/017 04/01/015 0/1/017 1 JEFFERSON CO HUMAN SVS-CONNECTIONS CNSLG, 1541 ANNEX RD, JEFFERSON, WI 5549 04/01/015 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 simon@countyofdane.com Phone: (608) 4-600 07/01/015 06/0/016 Fax: (608) 4-651 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 #: 695 1 W BELTLINE HIGHWAY, #15 MADISON, WI 571 Dane County Surveyor: William Rohner PAT CARRUTHERS Initial Cert: 1/01/006 Pcarruthers@genesissocialservices Phone: (608) 10-65 01/01/015 1/1/016 Fax: (608) 04-0648 CSAS-INTERVENTION DHS 75.16 CSAS-PREVENTION DHS 75.04 01/01/015 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 info@fsmad.org Phone: (608) 5-10 10/01/015 09/0/017 Fax: (608) 5-1 CSAS-PREVENTION DHS 75.04 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

HOPE HAVEN-REBOS UNITED, INC - CHRIS FARLEY HOUSE Lic #: 1774 810 W. OLIN AVENUE MADISON, WI 5715 Dane County Surveyor: Erin Taylor FRAN AUGUSTINE Initial Cert: 10/01/199 faugustine@ccmadison.org Phone: (608) 55-59 1/01/014 11/0/016 Fax: (608) 55-040 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 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 jcrc.james@yahoo.com Phone: (608) 467-914 11/01/014 10/1/016 Fax: (608) 467-915 CSAS-DAY TREATMENT DHS 75.1 11/01/014 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 lynn.brady@journeymhc.org Phone: (608) 80-700 0/01/014 0/9/016 Fax: (608) 80-707 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 5716 01/1/015 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 shanusa@crchealth.com Phone: (608) 4-00 07/01/015 1/1/015 Fax: (608) 4-1166 CSAS-NARCOTIC TREATMENT DHS 75.15 07/01/015 1/1/015 07/01/015 1/1/015 09/9/015 Page 17 of 1

MERITER HOSPITAL BEHAVIORAL SERVICES PROGRAM Lic #: 101 0 S. PARK STREET MADISON, WI 5715 Dane County Surveyor: Erin Taylor SUSAN JANTY Initial Cert: 01/01/1984 sjanty@meriter.com Phone: (608) 417-546 1/01/014 11/0/016 Fax: (608) 417-54 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 1/01/014 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 sjanty@meriter.com Phone: (608) 417-8144 1/01/014 11/0/016 Fax: (608) 71-457 1/01/014 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 Faugustine@ccmadison.org Phone: (608) 51-8881 1/01/014 11/0/016 Fax: (608) 4-001 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 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 wkohlhaas@qam-inc.com Phone: (608) 50-51 07/01/015 06/0/017 Fax: (608) 50-516 CSAS-NARCOTIC TREATMENT DHS 75.15 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 18 of 1

ROGERS MEMORIAL HOSPITAL - MADISON PARTIAL HOSPITALIZATION PROGRAM Lic #: 90 406 SCIENCE DRIVE RM #110 & 00 MADISON, WI 5711 Dane County Surveyor: Hannah Whaley DAVID GEBAUER Initial Cert: 10/1/010 DGebauer@rogershospital.org Phone: (608) 8-4411 11/01/01 10/1/015 Fax: (608) 8-441 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 08/0/014 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 tvieth@correctionalservices.org Phone: (608) 49-66 07/01/015 06/0/017 Fax: (608) 49-1954 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/015 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 slim@tellurian.org Phone: (608) -711 11/01/01 10/1/015 Fax: (608) -04 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 11/01/01 10/1/015 11/01/01 10/1/015 THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION, AND TRAINING INC Lic #: 1147 510 WALL STREET, #500 MADISON, WI 5718 Dane County Surveyor: Hannah Whaley KEVIN RANDALL Initial Cert: 0/01/198 christiancounselingmadison@gmail. Phone: (608) 74-894 0/01/014 0/1/016 Fax: (608) 74-878 0/01/014 0/1/016 0/01/014 0/1/016 09/9/015 Page 19 of 1

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 jhblack@wisc.edu Phone: (608) 8-9991 11/01/014 10/1/016 Fax: (608) 8-199 11/01/014 10/1/016 11/01/014 10/1/016 1 AIDS NETWORK, 600 WILLIAMSON STREET, MADISON, WI 570 11/01/014 01/1/015 1 THE PSYCHOLOGY CLINIC, INC - WI DELLS, 1000 HWY 1, WISCONSIN DELLS, WI 5965 11/01/014 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 5578 11/01/014 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 CGreen@uwhealth.org Phone: (608) 6-1111 0/01/014 01/1/016 Fax: (608) 6-9045 0/01/014 01/1/016 0/01/014 01/1/016 UW HEALTH BEHAVIORAL HEALTH & RECOVERY Lic #: 174 110 SOUTH PARK ST SUITE #400 MADISON, WI 5715 Dane County Surveyor: Erin Taylor MICHAEL WAUPOOSE Initial Cert: 01/01/199 michael.waupoose@uwmf.wisc.edu Phone: (608) 8-870 1/01/014 11/0/016 Fax: (608) 87-599 1/01/014 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 slim@tellurian.org Phone: (608) -711 08/01/015 07/1/017 Fax: (608) -5904 CSAS-INTERVENTION DHS 75.16 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 09/9/015 Page 0 of 1

TELLURIAN UCAN, INC. 00 FEMRITE DRIVE MONONA, WI 5716 Dane County Surveyor: William Rohner Lic #: 1900 SARAH LIM Initial Cert: 06/01/199 slim@tellurian.org Phone: (608) -711 06/01/014 05/1/016 Fax: (608) -045 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 06/01/014 05/1/016 OCEANHAWK COUNSELING ALTERNATIVES, LLC Lic #: 675 15 W MAIN STREET, #07A STOUGHTON, WI 5589 Dane County Surveyor: William Rohner JEAN DAUTE Initial Cert: 07/17/006 counseling@oceanhawk.net Phone: (608) 87-788 07/01/015 06/0/017 Fax: (877) 674-177 07/01/015 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 hkleinbrook@stohosp.com Phone: (608) 87-4 09/01/014 08/1/016 Fax: (608) 87-9 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 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 prairiec@netzero.net Phone: (608) 87-4814 08/01/014 07/1/016 Fax: (608) 85-49 08/01/014 07/1/016 08/01/014 07/1/016 09/9/015 Page 1 of 1

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 exdir@affiliatedcounseling.net Phone: (90) 887-8751 10/01/015 09/0/017 Fax: (90) 887-977 10/01/015 09/0/017 10/01/015 09/0/017 1 AFFILIATED COUNSELING CENTER, LLC, 17 FOREST AVENUE, FOND DU LAC, WI 5495 10/01/015 09/0/017 AGNESIAN HEALTHCARE, D.B.A. PSYCHIATRIC ASSOCIATES Lic #: 175 00 FRONT STREET, #D BEAVER DAM, WI 5916 Dodge County JIM SALASEK Initial Cert: 10/01/1984 salasekj@agnesian.com Phone: (90) 885-780 07/01/014 06/0/016 Fax: (90) 885-788 07/01/014 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 #: 764 199 COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 1/11/007 Aschultz@co.dodge.wi.us Phone: (90) 86-49 1/01/01 11/0/015 Fax: (90) 86-81 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

DODGE COUNTY HUMAN SERVICES AND HEALTH DEPARTMENT Lic #: 18 199 COUNTY RD DF JUNEAU, WI 509 Dodge County ALYSSA SCHULTZ Initial Cert: 10/01/1975 aschultz@co.dodge.wi.us Phone: (90) 86-4094 0/01/015 0/8/017 Fax: (90) 86-81 CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5048 0/01/015 0/8/017 MAYVILLE HIGH SCHOOL, 500 N. CLARK ST., MAYVILLE, WI 5050 0/01/015 0/8/017 MAYVILLE MIDDLE SCHOOL, 445 N. HENNINGER ST. RM 01, MAYVILLE, WI 5050 0/01/015 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 #: 178 19 HOSPITAL DRIVE WATERTOWN, WI 5098 Dodge County ERIC D BEAVER Initial Cert: 11/01/1981 ebeaver@uwhpwatertown.com Phone: (90) 6-4800 01/01/014 1/1/015 Fax: (90) 6-481 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 5551 01/01/014 1/1/015 09/9/015 Page of 1

Door County COUNSELING ASSOCIATES OF DOOR COUNTY, LLC Lic #: 150 60 N. 1TH AVENUE STURGEON BAY, WI 545 Door County WILLIAM G NICK Initial Cert: 11/16/199 cadc@dcwis.com Phone: (90) 74-9554 1/01/014 11/0/016 Fax: (90) 74-1591 1/01/014 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 5401 0/0/015 11/0/016 DOOR COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 18 41 NEBRASKA STREET STURGEON BAY, WI 545 Door County CORI MCFARLANE Initial Cert: 01/01/1978 cmcfarlane@co.door.wi.us Phone: (90) 746-7155 10/01/014 09/0/016 Fax: (90) 746-49 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 #: 057 41 NEBRASKA STREET STURGEON BAY, WI 545 Door County JOSEPH KREBSBACH Initial Cert: 1/01/014 jkoschkee@co.door.wi.us Phone: (90) 746-7155 1/01/014 11/0/015 Fax: (90) 746-49 CCS REGIONAL MODEL SHARED SERVICES DHS 6 1/01/014 11/0/015 09/9/015 Page 4 of 1

Douglas County DOUGLAS COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 847 116 N 14TH STREET SUITE 400 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong DAVE LONGSDORF Initial Cert: 01/06/009 dave.longsdorf@douglascountywi.o Phone: (715) 95-104 01/01/015 1/1/016 Fax: (715) 95-165 CSAS-INTERVENTION DHS 75.16 01/01/015 1/1/016 HUMAN DEVELOPMENT CENTER MENTAL HEALTH CENTER Lic #: 14 1500 N 4TH STREET, #00 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong BETSY BYLER Initial Cert: 1/01/198 betsy.byler@hdchrc.org Phone: (715) 9-816 07/01/014 06/0/016 Fax: (715) 9-6055 07/01/014 06/0/016 07/01/014 06/0/016 BRYANT ELEMENTARY SCHOOL, 14 CENTRAL AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 COOPER ELEMENTARY, 1807 MISSOURI AVE., SUPERIOR, WI 54880 04/0/016 06/0/016 FOUR CORNERS ELEMENTARY, 4465 COUNTY RD. B, SUPERIOR, WI 54880 04/0/016 06/0/016 GREAT LAKES ELEMENTARY, 19 N. 8TH ST. EAST, SUPERIOR, WI 54880 04/0/016 06/0/016 LAKE SUPERIOR ELEMENTARY, 600 E. RD ST., SUPERIOR, WI 54880 04/0/016 06/0/016 NORTHERN LIGHTS ELEMENTARY, 101 NORTH 8TH ST, SUPERIOR, WI 54880 07/01/014 06/0/016 NORTHWESTERN ELEMENTARY SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI 54854 07/01/014 06/0/016 NORTHWESTERN HIGH SCHOOL, 4751 SOUTH COUNTY RD F, MAPLE, WI 54854 07/01/014 06/0/016 NORTHWESTERN MIDDLE SCHOOL, 105 EAST US HWY, POPLAR, WI 54864 07/01/014 06/0/016 SOLON SPRINGS SCHOOL, 899 EAST BALDWIN AVE, SOLON SPRINGS, WI 5487 07/01/014 06/0/016 SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI 54880 07/01/014 06/0/016 RIDGEWOOD RECOVERY, INC. DBA THE SUPERIOR TREATMENT CENTER Lic #: 196 1507 TOWER AVENUE, #07 SUPERIOR, WI 54880 Douglas County Surveyor: Polly Wong KATHY FETSCH Initial Cert: 0/01/1997 info@superiortreatmentcenter.org Phone: (715) 9-900 04/01/015 0/8/017 Fax: (715) 9-8041 04/01/015 0/8/017 09/9/015 Page 5 of 1

Dunn County ARBOR PLACE, INC. 4076 KOTHLOW AVE MENOMONIE, WI 54751 Dunn County Surveyor: Roderic Senn Lic #: 1050 JILL GAMEZ Initial Cert: 1/01/199 info@arborplaceinc.com Phone: (715) 5-457 10/01/015 09/0/017 Fax: (715) 5-455 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-PREVENTION DHS 75.04 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 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 10/01/015 09/0/017 09/9/015 Page 6 of 1

Eau Claire County FIRST THINGS FIRST COUNSELING & CONSULTING Lic #: 148 519 N HILLCREST PKWY STE 01 ALTOONA, WI 5470 Eau Claire County Surveyor: Roderic Senn CHASTITY DRAKE Initial Cert: 09/01/1990 chastitydrake@hotmail.com Phone: (715) 8-84 08/01/015 07/1/017 Fax: (715) 8-5007 08/01/015 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 Anita.Kuster@lsswis.org Phone: (715) 8-046 0/01/014 0/9/016 Fax: (715) 8-1505 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/014 0/9/016 0/01/014 0/9/016 CAILLIER CLINIC, LTD. 60 STEIN BLVD EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 1119 PAUL CAILLIER Initial Cert: 01/01/198 caillier1@aol.com Phone: (715) 86-0064 05/18/015 11/0/016 Fax: (715) 86-0065 05/18/015 11/0/016 05/18/015 11/0/016 1 CAILLIER CLINIC LTD., 700 WOLSKE BAY RD, STE 10, MENOMONIE, WI 54751 05/18/015 11/0/016 CAILLIER CLINIC, LTD, 0 NORTH MAIN STREET, RICE LAKE, WI 54868 05/18/015 11/0/016 EAU CLAIRE ACADEMY, DIVISION OF CLINICARE CORPORATION Lic #: 19 550 N. DEWEY STREET EAU CLAIRE, WI 5470 Eau Claire County Surveyor: Roderic Senn VERA MATTER Initial Cert: 0/01/1994 matter@clinicarecorp.com Phone: (715) 84-6681 09/01/015 08/1/017 Fax: (715) 84-9954 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 CSAS-TRANSITIONAL RESIDENTIAL WITH TELEHEALTH HFS 75.14 09/01/015 08/1/017 09/01/015 08/1/017 09/9/015 Page 7 of 1

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 marcy.hurlburt@cmglp.com Phone: (715) 84-1078 1/01/014 11/0/016 Fax: (715) 84-118 CSAS-NARCOTIC TREATMENT DHS 75.15 1/01/014 11/0/016 1/01/014 11/0/016 GATEWAY COUNSELING, LLC 459 LONDON ROAD EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 08 CHRIS BRAHAN Initial Cert: 0/09/015 chrisgateway@clearwire.net Phone: (715) 55-175 0/09/015 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 matter@clinicarecorp.com Phone: (715) 84-6681 09/01/015 08/1/017 Fax: (715) 84-447 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 #: 159 16 CRAIG ROAD EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn DAREN DREGNEY Initial Cert: 11/01/1986 ddregney@lsswis.org Phone: (715) 85-9110 07/01/014 06/0/016 Fax: (715) 80-4098 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/014 06/0/016 07/01/014 06/0/016 09/9/015 Page 8 of 1

MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC Lic #: 1511 11 WHIPPLE STREET EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn KARLENE PHILLIPS Initial Cert: 06/01/1981 phillips.karlene@mayo.edu Phone: (715) 88-74 1/01/014 11/0/016 Fax: (715) 88-649 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 1/01/014 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 Ming.Cindy@mayo.edu Phone: (715) 88-569 01/01/015 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 54758 07/07/015 1/1/016 1 MAYO CLINIC HEALTH SYSTEM-BLOOMER CLINIC, 1501 THOMPSON STREET, BLOOMER, WI 5474 01/01/015 1/1/016 MAYO CLINIC HEALTH SYSTEM NORTHLAND, 1 S MAIN STREET, RICE LAKE, WI 54868 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) 514-4600 10/01/014 09/0/016 Fax: (715) 514-4608 CSAS-INTERVENTION DHS 75.16 10/01/014 09/0/016 SACRED HEART HOSPITAL 900 W. CLAIREMONT AVENUE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 09 THERESA MACKEY Initial Cert: 0/01/198 theresa.mackey@hshs.org Phone: (715) 717-47 01/01/015 1/1/016 Fax: (715) 717-4996 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 01/01/015 1/1/016 01/01/015 1/1/016 01/01/015 1/1/016 09/9/015 Page 9 of 1

SYNERGY GROUP OF EAU CLAIRE, SC DBA VANTAGE POINT CLINIC & ASSESSMENT CENTER Lic #: 1408 005 HIGHLAND AVE EAU CLAIRE, WI 54701 Eau Claire County Surveyor: Roderic Senn MARK BJERKE Initial Cert: 08/01/1990 bjerkem@vantagepointclinic.com Phone: (715) 84-171 09/01/014 08/1/016 Fax: (715) 84-174 09/01/014 08/1/016 09/01/014 08/1/016 1 VANTAGE POINT CLINIC & ASSESSMENT CENTER, 54 GOLF ROAD, SUITE #F, EAU CLAIRE, WI 547 10/01/015 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 54701 PUTNAM HEIGHTS ELEMENTARY, 6 W MACARTHUR AVE, EAU CLAIRE, WI 54701 RICE LAKE HIGH SCHOOL, 0 WEST WISCONSIN STREET, RICE LAKE, WI 54868 ROBBINS ELEMENTARY, 8 E. HAMILTON AVE, EAU CLAIRE, WI 54701 WOODLAND ELEMENTARY SCHOOL, 808 EAST WOODLAND AVENUE, BARRON, WI 5481 09/01/014 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 54701 Eau Claire County Surveyor: Roderic Senn Lic #: 196 ROBERT PEITZMAN Initial Cert: 0/01/1989 rob@triniteam.org Phone: (715) 858-9801 04/01/014 0/1/016 Fax: (715) 86-8104 04/01/014 0/1/016 1 BUFFALO CO COURTHOUSE- DHS TRINITEAM, 407 SOUTH SECOND ST, ALMA, WI 54610 04/01/014 0/1/016 09/9/015 Page 0 of 1

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 fwrbeacon@tds.net Phone: (90) 9-999 06/01/014 05/1/016 Fax: (90) 9-40 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 06/01/014 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 dave@blandinehouse.org Phone: (90) 9-9487 01/01/014 1/1/015 Fax: (90) 9-9184 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/014 1/1/015 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS Lic #: 150 459 E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/01/1978 community.programs@fdlco.wi.gov Phone: (90) 99-500 01/01/014 1/1/015 Fax: (90) 99-19 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-PREVENTION DHS 75.04 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 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 FOND DU LAC COUNTY DEPARTMENT OF COMMUNITY PROGRAMS CCS Lic #: 680 459 E FIRST STREET FOND DU LAC, WI 5495 Fond Du Lac County REBECCA BELL Initial Cert: 07/18/006 rebecca.bell@fdlco.wi.gov Phone: (90) 99-71 08/01/015 07/1/017 Fax: (90) 99-19 COMPREHENSIVE COMMUNITY SERVICES (CCS) DHS 6 08/01/015 07/1/017 09/9/015 Page 1 of 1

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 eellis@premiercare.org Phone: (90) 66-677 05/05/015 04/0/016 Fax: (800) 77-9518 CSAS-NARCOTIC TREATMENT DHS 75.15 05/05/015 04/0/016 05/05/015 04/0/016 ST. AGNES HOSPITAL BEHAVIORAL HEALTH SERVICES Lic #: 1847 40 EAST DIVISION STREET FOND DU LAC, WI 5495 Fond Du Lac County JAMES SALASEK PHD Initial Cert: 05/01/1980 salasekj@agnesian.com Phone: (90) 96-400 01/01/014 1/1/015 Fax: (90) 96-89 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 01/01/014 1/1/015 1 ST AGNES HOSPITAL BEHAVIORAL HEALTH SVS, 60 BROWN STREET, WAUPUN, WI 596 01/01/014 1/1/015 ST AGNES HOSPITAL BEHAV HLTH, 790 EASTGATE DRIVE, RIPON, WI 54971 ST AGNES HOSPITAL BEHAVIORAL HEALTH, 845 PARKSIDE, RIPON, WI 54971 01/01/014 06/18/015 06/19/015 1/1/015 09/9/015 Page of 1

Forest County FOREST COUNTY POTAWATOMI AODA DEPARTMENT Lic #: 086 5519 KAK YOT LANE CRANDON, WI 5450 Forest County TINA GARCIA Initial Cert: 04/01/015 Tina.Garcia@fcpotawatomi-nsn.gov Phone: (715) 478-4888 04/01/015 0/1/016 Fax: (715) 478-4499 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 04/01/015 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 paulette.smith@ssc-nsn.gov Phone: (715) 478-5180 0/01/015 1/1/015 Fax: (715) 478-5904 0/01/015 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 cknapp@unifiedservices.org Phone: (608) 7-657 07/01/015 06/0/017 Fax: (608) 7-4417 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 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

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 gholcomb@gchsd.org Phone: (608) 8-99 01/01/014 1/1/015 Fax: (608) 8-9480 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 sfarrey@gchsd.org Phone: (608) 8-910 06/01/015 05/1/016 Fax: (608) 8-9480 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 550 06/01/015 05/1/016 09/9/015 Page 4 of 1

Green Lake County GREEN LAKE COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES Lic #: 189 571 COUNTY ROAD A GREEN LAKE, WI 54941 Green Lake County Surveyor: Erin Taylor JANA TETZLAFF Initial Cert: 04/01/1977 glcdhhs@co.green-lake.wi.us Phone: (90) 94-4070 11/01/014 10/1/016 Fax: (90) 94-419 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS 75.04 CSAS-PREVENTION WITH TELEHEALTH DHS 75.04 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 #: 599 571 COUNTY ROAD A GREEN LAKE, WI 54941 Green Lake County Surveyor: Hannah Whaley JANA TETZLAFF Initial Cert: 08//005 glcdhhs@co.green-lake.wi.us Phone: (90) 94-4070 10/01/015 0/1/016 Fax: (90) 94-419 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 11505-6TH AVENUE, NORTH PLYMOUTH, MN 55441 Hennepin County (MN) Surveyor: Roderic Senn Lic #: 199 SCOTT HESSELTINE Initial Cert: 0/01/1990 shesseltine@hazeldenbettyford.org Phone: (76) 509-800 05/01/015 04/0/017 Fax: (651) 1-4551 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 5 of 1

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 cknapp@unifiedservices.org Phone: (608) 95-776 07/01/015 06/0/017 Fax: (608) 95-174 07/01/015 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 kolsonc@ironcountywi.org Phone: (715) 561-66 07/01/015 06/0/016 Fax: (715) 561-18 CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 IRON COUNTY HUMAN SERVICES DEPARTMENT AND ASSOCIATES Lic #: 47 00 TACONITE STREET, #01 HURLEY, WI 5454 Iron County Surveyor: Polly Wong CAROLYN KOLSON-JANOV Initial Cert: 0/01/00 ironcountyhsd@ironcountywi.org Phone: (715) 561-66 04/01/015 0/8/017 Fax: (715) 561-18 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-PREVENTION DHS 75.04 CSAS-PREVENTION WITH TELEHEALTH DHS 75.04 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 54547 04/01/015 0/8/017 HURLEY SCHOOL DISTRICT, 550 W RANGE VIEW DR, HURLEY, WI 5454 MERCER SCHOOL DISTRICT, 690 W MARGARET STREET, MERCER, WI 54547 04/01/015 0/8/017 04/01/015 0/8/017 09/9/015 Page 6 of 1

Jackson County HO-CHUNK NATION DEPARTMENT OF HEALTH DIVISION OF BEHAVIORAL HEALTH Lic #: 141 W9850 AIRPORT RD BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn TERRY GREENDEER Initial Cert: 05/01/199 Terry.greendeer@ho-chunk.com Phone: (715) 84-9851 11/01/014 10/1/016 Fax: (715) 84-44 11/01/014 10/1/016 11/01/014 10/1/016 NEKOOSA HEALTH OFFICE, 15 1ST STREET, NEKOOSA, WI 54457 11/01/014 10/1/016 THREE RIVERS HOUSE, 74 MAIN STREET, LA CROSSE, WI 54601 11/01/014 10/1/016 TOMAH HEALTH OFFICE, 774 HWY 1 EAST, TOMAH, WI 54660 11/01/014 10/1/016 WELLNESS CENTER HEALTH OFFICE, S845 WHITE EAGLE ROAD, BARABOO, WI 591 11/01/014 10/1/016 WITTENBERG HEALTH OFFICE, N740 HWY 49 NORTH, WITTENBERG, WI 54499 11/01/014 10/1/016 JACKSON COUNTY DEPT OF HEALTH & HUMAN SERVICES Lic #: 957 40 HIGHWAY 54 WEST BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn HEATHER L. HAINZ Initial Cert: 01/01/01 heather.hainz@co.jackson.wi.us Phone: (715) 84-401 09/01/015 08/1/016 Fax: (715) 84-771 09/01/015 08/1/016 09/01/015 08/1/016 KROHN CLINIC, LTD. 610 W ADAMS STREET BLACK RIVER FALLS, WI 54615 Jackson County Surveyor: Roderic Senn Lic #: 147 SHERIE SPAULDING BH MGR Initial Cert: 0/01/1988 spauldings@krohnclinic.com Phone: (715) 84-1901 05/01/015 04/0/017 Fax: (715) 84-1890 05/01/015 04/0/017 05/01/015 04/0/017 09/9/015 Page 7 of 1

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 kathic@jeffersoncountywi.gov Phone: (90) 674-105 06/01/014 05/1/016 Fax: (90) 674-611 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 #: 64 1541 ANNEX ROAD JEFFERSON, WI 5549 Jefferson County Surveyor: William Rohner KIMBERLY PROPP Initial Cert: 0/15/006 kimp@jeffersoncountywi.gov Phone: (90) 674-877 0/01/015 0/8/017 Fax: (90) 674-59 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 jschmidt1611@familyresourcesinc.c Phone: (90) 61-4100 11/01/014 10/1/016 Fax: (90) 61-8801 11/01/014 10/1/016 11/01/014 10/1/016 FAMILY RESOURCES ASSOCIATES INC, 1 N MAIN STREET, LAKE MILLS, WI 5551 11/01/014 10/1/016 09/9/015 Page 8 of 1

Juneau County JUNEAU COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 145 0 E LACROSSE STREET MAUSTON, WI 5948 Juneau County Surveyor: Hannah Whaley JOANN GEIGER Initial Cert: 01/01/1988 jgeiger@co.juneau.wi.us Phone: (608) 847-9474 01/01/014 1/1/015 Fax: (608) 847-941 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 #: 000 0 E LA CROSSE STREET RM # MAUSTON, WI 5948 Juneau County Surveyor: Erin Taylor JOANN GEIGER Initial Cert: 04/01/01 jgeiger@co.juneau.wi.us Phone: (608) 847-9474 04/01/015 0/1/017 Fax: (608) 847-941 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 09/9/015 Page 9 of 1

Kenosha County COMPASSIONATE CARE COUNSELING (A DIV OF COMPETITIVE EDGE EMP ASSURANCE SVS) Lic #: 44 64-17TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner KEVIN M ORLAKIS Initial Cert: 06/01/00 korlakis@sbcglobal.net Phone: (6) 65-611 06/01/014 05/1/016 Fax: (6) 605-0809 06/01/014 05/1/016 GENESIS BEHAVIORAL SERVICES OPTIONS RESIDENTIAL PROGRAM Lic #: 00 6755-14TH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/14/000 gina.singletery@corizonhealth.com Phone: (6) 654-068 04/01/014 0/1/016 Fax: (6) 654-886 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/014 0/1/016 04/01/014 0/1/016 HOPE COUNCIL ON ALCOHOL & OTHER DRUG ABUSE, INC. Lic #: 104 594 - SIXTH AVENUE KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner GUIDA BROWN Initial Cert: 0/15/1990 info@hopecouncil.org Phone: (6) 658-8166 0/01/015 0/8/017 Fax: (6) 658-810 CSAS-INTERVENTION DHS 75.16 0/01/015 0/8/017 KARE CENTER 510-60TH STREET KENOSHA, WI 5140 Kenosha County Surveyor: William Rohner Lic #: 1014 KARI FOSS Initial Cert: 10/10/1987 kfoss@khds.org Phone: (6) 654-586 08/01/014 07/1/016 Fax: (6) 65-080 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 08/01/014 07/1/016 KENOSHA COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 589 8600 SHERIDAN RD #100 KENOSHA, WI 514 Kenosha County Surveyor: William Rohner KATIE HANKS Initial Cert: 05/01/005 katie.hanks@kenoshacounty.org Phone: (6) 697-4648 05/01/015 04/0/017 Fax: (6) 697-4655 CCS REGIONAL MODEL SHARED SERVICES DHS 6 05/01/015 04/0/017 KENOSHA HUMAN DEVELOPMENT SERVICES, INC (KHDS), 5407 8TH AVENUE, KENOSHA, WI 5140 05/01/015 04/0/017 09/9/015 Page 40 of 1

MOORE AND ASSOCIATES/BIRDS OF A FEATHER, INC. Lic #: 61 650 SHERIDAN ROAD, # KENOSHA, WI 514 Kenosha County Surveyor: William Rohner TONY MOORE Initial Cert: 09/14/005 Tmoore@mooreandassociates.biz Phone: (6) 605-1444 10/01/015 09/0/017 Fax: (6) 605-1404 CSAS-DAY TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 OAKWOOD CLINICAL ASSOCIATES, LTD. 4109-67TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 08 AMY ANDERSON Initial Cert: 0/5/1991 amyanderson@oakwoodclinical.com Phone: (6) 65-980 0/01/014 0/9/016 Fax: (6) 65-91 0/01/014 0/9/016 0/01/014 0/9/016 OAKWOOD CLINICAL ASSOCIATES LTD, 470-75TH ST, PADDOCK LAKE, WI 5168 0/01/014 0/9/016 PROFESSIONAL SERVICES GROUP, INC. 108 6RD STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner Lic #: 1749 BRIAN WOLF Initial Cert: 06/01/198 bwolf@psgcip.com Phone: (6) 65-406 04/01/014 0/1/016 Fax: (6) 65-408 04/01/014 0/1/016 04/01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 116 S 70TH STREET # 508, WEST ALLIS, WI 514 04/01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 14 NORTH 8TH AVE, WEST BEND, WI 5095 04/01/014 0/1/016 PROFESSIONAL SERVICES GROUP, 565 MILWAUKEE AVE., BURLINGTON, WI 5105 05/01/015 0/1/016 PROFESSIONAL SERVICES GROUP, 800 GOOLD, RACINE, WI 540 07/9/014 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 pauldefazio@wi.rr.com Phone: (6) 654-0487 05/01/014 04/0/016 Fax: (6) 654-44 05/01/014 04/0/016 05/01/014 04/0/016 09/9/015 Page 41 of 1

ROGERS MEMORIAL HOSPITAL CHILD AND ADOLESCENT DAY TREATMENT PROGRAM Lic #: 4 9916-75TH STREET KENOSHA, WI 514 Kenosha County Surveyor: William Rohner JODY PAHLAVAN PSY.D. Initial Cert: 04/8/00 jpahlavan@rogershospital.org Phone: (6) 94-4000 05/01/014 04/0/016 Fax: (6) 94-7740 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 61.75 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 #: 1466 810 LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON, PHD Initial Cert: 0/01/1977 jacobsom@kewauneeco.org Phone: (90) 88-700 0/01/015 01/1/017 Fax: (90) 88-7044 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 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 #: 781 810 LINCOLN STREET KEWAUNEE, WI 5416 Kewaunee County MONICA JACOBSON Initial Cert: 0/11/008 jacobsom@kewauneeco.org Phone: (90) 88-704 04/01/014 0/1/016 Fax: (90) 88-7044 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

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 btodd@correctionalservices.org Phone: (608) 784-66 08/01/015 07/1/017 Fax: (608) 784-84 CSAS-INTERVENTION DHS 75.16 08/01/015 07/1/017 08/01/015 07/1/017 COULEE COUNCIL ON ADDICTIONS, INC. 91 WEST AVENUE SOUTH LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 140 LORIE LAUTZ Initial Cert: 11/01/1986 lorie@couleecouncil.org Phone: (608) 784-4177 11/01/014 10/1/016 Fax: (608) 784-60 CSAS-PREVENTION DHS 75.04 11/01/014 10/1/016 11/01/014 10/1/016 1 YWCA OPHELIA HOUSE, 17 S 7TH STREET, LA CROSSE, WI 54601 11/01/014 10/1/016 DRIFTLESS RECOVERY SERVICES INC 444 MAIN ST SUITE 01 LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 01 BRETT KNUTSON Initial Cert: 04/14/014 bknutson@driftlessrecovery.com Phone: (608) 519-5908 04/01/015 0/1/017 Fax: (608) 519-5909 04/01/015 0/1/017 04/01/015 0/1/017 FAMILY AND CHILDREN'S CENTER 1707 MAIN STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 115 VANESSA SOUTHWORTH Initial Cert: 0/01/1994 vsouthworth@fccnetwork.org Phone: (608) 785-0001 11/01/01 10/1/015 Fax: (608) 785-000 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 54665 11/01/01 10/1/015 FAMILY AND CHILDREN'S CENTER, 409 COUNTY RD R, BLACK RIVER FALLS, WI 54615 11/01/01 11/7/01 09/9/015 Page 4 of 1

GUNDERSEN CLINIC LIMITED BEHAVIORAL HEALTH Lic #: 191 186 SOUTH AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/1984 skmelde@gundersenhealth.org Phone: (608) 775-649 1/01/014 11/0/016 Fax: (608) 775-6055 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,, 18606 ERVIN STREET, WHITEHALL, WI 5477 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 6 NORTH ND STREET, LA CRESCENT, MN 55947 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD, 805 MAIN AVE SOUTH, HARMONY, MN 5599 1/01/014 11/0/016 1 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 110 JEFFERSON STREET, WEST UNION, IA 5175 1/01/014 11/0/016 1 GUNDERSON CLINIC LTD, 5791 OSSEO ROAD, INDEPENDENCE, WI 54747 1/01/014 11/0/016 1 GUNDERSON CLINIC LTD, 40 SOUTH PETERSON AVE, BLAIR, WI 54616 1/01/014 11/0/016 1 LA CROSSE CO LAKEVIEW HEALTH CENTER, 90 GARLAND STREET, E, WEST SALEM, WI 54669 1/01/014 11/0/016 1 RICHLAND MEDICAL CENTER, 01 EAST ND STREET, RICHLAND CENTER, WI 5581 1/01/014 11/0/016 1 VERNON MEMORIAL HEALTHCARE, 507 SOUTH MAIN ST, VIROQUA, WI 54665 1/01/014 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 54660 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI 54656 GUNDERSEN LUTHERAN MEDICAL CENTER, 1-16TH AVE SOUTH, ONALASKA, WI 54650 GUNDERSEN LUTHERAN MEDICAL CENTER, 111 GUNDERSEN DRIVE, ONALASKA, WI 54650 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 LUTHERAN MEDICAL CENTER, INC. BEHAVIORAL HEALTH Lic #: 150 1910 SOUTH AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 0/01/198 skmelde@gundersenhealth.org Phone: (608) 775-649 1/01/014 11/0/016 Fax: (608) 775-6055 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-NARCOTIC TREATMENT DHS 75.15 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 1/01/014 11/0/016 GUNDERSEN CLINIC, LTD., BEHAVIORAL HEALTH, 14 NORTH COURT STREET, SPARTA, WI 54656 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 1-16TH AVENUE SOUTH, ONALASKA, WI 54650 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 18606 ERVIN STREET, WHITEHALL, WI 5477 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 111 GUNDERSEN DRIVE, ONALASKA, WI 54650 1/01/014 11/0/016 GUNDERSEN LUTH MED CTR BEHAV HEALTH, 601 N SUPERIOR AVENUE, TOMAH, WI 54660 1/01/014 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

GUNDERSEN LUTHERAN MEDICAL CENTER, INC. UNITY HOUSE FOR MEN Lic #: 1951 19-194 MILLER STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/199 skmelde@gundersenhealth.org Phone: (608) 775-475 1/01/014 11/0/016 Fax: (608) 775-4791 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR MEN Lic #: 78 1918-190 MILLER STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/008 skmelde@gundersenhealth.org Phone: (608) 775-475 1/01/014 11/0/016 Fax: (608) 775-4791 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 11/0/016 1/01/014 11/0/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., UNITY HOUSE FOR WOMEN Lic #: 195 11 FIFTH AVENUE, SOUTH LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 11/01/199 skmelde@gundersenhealth.org Phone: (608) 775-4718 1/01/014 11/0/016 Fax: (608) 775-4710 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 11/0/016 1/01/014 11/0/016 HIAWATHA VALLEY MENTAL HEALTH CENTER 19 MAIN STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 97 JULIE HANSON Initial Cert: 0/01/011 julieh@hvmhc.org Phone: (608) 796-1168 0/01/015 0/8/017 Fax: (608) 796-1944 CSAS-INTERVENTION DHS 75.16 CSAS-PREVENTION DHS 75.04 0/01/015 0/8/017 0/01/015 0/8/017 09/9/015 Page 45 of 1

LA CROSSE COUNTY HUMAN SERVICES 00 N 4TH STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 1488 BEV TRUSSONI Initial Cert: 0/01/1978 btrussoni@@lacrossecounty.org Phone: (608) 785-6107 05/01/014 04/0/016 Fax: (608) 785-61 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 54669 10/01/015 04/0/016 LA CROSSE COUNTY HUMAN SERVICES VINE STREET, ROOM 740 LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn Lic #: 95 BECKY SPANJERS Initial Cert: 01/19/011 bspanjers@lacrossecounty.org Phone: (608) 789-4895 05/01/014 04/0/016 Fax: (608) 785-5715 CSAS-INTERVENTION DHS 75.16 05/01/014 04/0/016 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN HEALTHCARE Lic #: 170 700 WEST AVENUE LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn NAN ANDERSON Initial Cert: 09/01/1977 anderson.nanette@mayo.edu Phone: (608) 9-647 04/01/015 0/1/017 Fax: (608) 9-976 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 04/01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 46 of 1

MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER INC Lic #: 16 1 S 11TH STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn LACIE ANTHONY Initial Cert: 09/01/1977 Anthony.Lacie@mayo.edu Phone: (608) 9-9555 06/01/015 05/1/017 Fax: (608) 9-979 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS 61.75 06/01/015 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 5461 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - HOLMEN CLINIC, 10 MAIN STREET, HOLMEN, WI 5466 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - ONALASKA CLINIC, 191 THEATER ROAD, ONALASKA, WI 54650 06/01/015 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 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SIENA HALL, 608 S 11TH STREET, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - SPARTA, 10 W. MAIN ST, SPARTA, WI 54656 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - TOMAH, 5 BUTTS AVENUE, TOMAH, WI 54660 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - VILLA SUCCES, 11 PRAIRIE STREET, PRAIRIE DU CHIEN, WI 581 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN - WOMEN'S LAAR HOUSE, 1005 JACKSON STREET, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 700 WEST AVENUE SOUTH, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC FRANCISCAN MEDICAL CENTER, 800 WEST AVENUE SOUTH, LA CROSSE, WI 54601 06/01/015 05/1/017 MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER, INC.- SCARSETH HOUSE Lic #: 160 55 S. 17TH STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn SALLY SIBBALD Initial Cert: 01/01/1991 sibbald.sally@mayo.edu Phone: (608) 9-454 04/01/015 0/1/017 Fax: (608) 78-1811 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/015 0/1/017 04/01/015 0/1/017 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC - WOMEN'S LAAR HOUSE Lic #: 510 1005 JACKSON STREET LA CROSSE, WI 54601 La Crosse County Surveyor: Roderic Senn JULIE CONWAY Initial Cert: 0/19/004 Conway.Julie@mayo.edu Phone: (608) 9-6147 04/01/014 0/1/016 Fax: (608) 9-9511 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/014 0/1/016 04/01/014 0/1/016 09/9/015 Page 47 of 1

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 cskolnik@lacrossecounty.org Phone: (608) 785-6019 07/01/015 06/0/016 Fax: (608) 785-61 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 54656 07/01/015 06/0/016 ADDICTION MEDICAL SOLUTIONS OF WISCONSIN LLC Lic #: 971 95 EAST 16 FRONTAGE RD #100 ONALASKA, WI 54650 La Crosse County Surveyor: Roderic Senn PATRICIA RUDA Initial Cert: 09/17/01 pruda@addictionmedical.net Phone: (608) 78-0506 09/01/015 08/1/016 Fax: (608) 78-04 CSAS-NARCOTIC TREATMENT DHS 75.15 09/01/015 08/1/016 09/01/015 08/1/016 GUNDERSEN LUTHERAN MEDICAL CENTER, INC., BEHAVIORAL HEALTH Lic #: 80 1-16TH AVENUE, SOUTH ONALASKA, WI 54650 La Crosse County Surveyor: Roderic Senn SARAH MELDE Initial Cert: 1/01/000 skmelde@gundersenhealth.org Phone: (608) 775-87 1/01/014 11/0/016 Fax: (608) 775-8661 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 1/01/014 11/0/016 1/01/014 11/0/016 Lafayette County LAFAYETTE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 1490 67 N. MAIN STREET DARLINGTON, WI 550 Lafayette County Surveyor: Cynthia Lindgren SHANE SCHUHMACHER Initial Cert: 10/01/1975 SSchuhmacher@lchsd.org Phone: (608) 776-4800 11/01/01 10/1/015 Fax: (608) 776-4914 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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

Lincoln County ANDERSON & ASSOCIATES COUNSELING AND PSYCHOLOGIST SERVICES Lic #: 59 71 EAST SECOND ST MERRILL, WI 5445 Lincoln County Surveyor: Polly Wong BREEZY BONNEVILLE Initial Cert: 04/01/004 cwpsmerrill@hotmail.com Phone: (715) 59-8080 04/01/015 0/1/017 Fax: (715) 59-8099 04/01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 49 of 1

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 4cbies@gmail.com Phone: (90) 86-0708 04/1/015 0/1/016 Fax: CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/1/015 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 4CBies@gmail.com Phone: (90) 894-174 05/15/015 04/0/016 Fax: CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/15/015 04/0/016 MANITOWOC COUNTY HUMAN SERVICES DEPARTMENT Lic #: 1555 96 S. 8TH STREET MANITOWOC, WI 540 Manitowoc County JEFF JENSWOLD Initial Cert: 10/01/1975 humanservices@co.manitowoc.wi.u Phone: (90) 68-40 11/01/01 10/1/015 Fax: (90) 68-44 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 711 96 S. 8TH STREET MANITOWOC, WI 541 Manitowoc County JEFF JENSWOLD Initial Cert: 0/06/007 humanservices@co.manitowoc.wi.u Phone: (90) 68-40 0/01/015 0/9/016 Fax: (90) 68-44 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/9/016 09/9/015 Page 50 of 1

PHOENIX BEHAVIORAL HEALTH SERVICES, LLC 115 E. WALDO BOULEVARD MANITOWOC, WI 540 Manitowoc County Lic #: 1591 TODD EIDEN, PHD Initial Cert: 08/6/1991 drteiden@gmail.com Phone: (90) 68-111 11/01/014 10/1/016 Fax: (90) 68-5087 11/01/014 10/1/016 11/01/014 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 111 NORTH 7TH STREET, SHEBOYGAN, WI 5081 01/01/015 10/1/016 1 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 807 CENTER STREET, SHEBOYGAN, WI 5081 11/01/014 1/1/014 PHOENIX BEHAVIORAL HEALTH SERVICES, LLC, 110 LINCOLN ST, WISCONSIN RAPIDS, WI 54494 08/5/016 10/1/016 09/9/015 Page 51 of 1

Marathon County COURAGE TO CHANGE RECOVERY 106 GALVIN ROAD ABBOTSFORD, WI 54405 Marathon County Surveyor: Polly Wong Lic #: 180 RAE ANN WICHLACZ Initial Cert: 01/07/000 wichlacz@pcpros.net Phone: (715) -0480 11/01/01 10/1/015 Fax: (715) -1611 11/01/01 10/1/015 11/01/01 10/1/015 1 COURAGE TO CHANGE RECOVERY, 880 E PERKINS, #10, MEDFORD, WI 54451 11/01/01 10/1/015 COURAGE TO CHANGE RECOVERY, 188 N LAKE AVENUE, PO BOX, PHILLIPS, WI 54555 CHEQUAMEGON HIGH SCHOOL, 400 9TH STREET, NORTH, PARK FALLS, WI 5455 11/01/01 10/1/015 10/01/014 10/1/015 ATTIC CORRECTIONAL SERVICES, INC-ACS CLINICAL SERVICES, LLC-WAUSAU Lic #: 807 90 N SECOND STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong MARK ROSSANO Initial Cert: 10/01/008 mrossano@acsclinicalservices.org Phone: (715) 55-0671 10/0/014 09/0/016 Fax: (715) 55-0667 10/0/014 09/0/016 CHARIS COUNSELING, LLC 60 W. STEWART AVENUE, #10 WAUSAU, WI 54401 Marathon County Surveyor: Polly Wong Lic #: 464 LORI THOMPSON Initial Cert: 09/01/00 lthompson@chariscounselingwi.com Phone: (715) 848-055 09/01/014 08/1/016 Fax: (715) 848-8665 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 54449 09/01/014 08/1/016 09/9/015 Page 5 of 1

COMPASS COUNSELING WAUSAU, LLC 50 GRANT STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong Lic #: 99 TRACY PETERSON Initial Cert: 0/5/011 tracypetersonccw@gmail.com Phone: (715) 845-549 04/01/014 0/1/016 Fax: (715) 848-5645 04/01/014 0/1/016 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU LLC, 19 SUPERIOR ST, ANTIGO, WI 54409 04/01/014 1/1/014 1 COMPASS COUNSELING WAUSAU LLC, 60 E WALL STREET, EAGLE RIVER, WI 5451 04/01/014 0/1/015 1 COMPASS COUNSELING WAUSAU, LLC, 1004 FIRST ST, STE, STEVENS POINT, WI 54481 10/0/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 50 8TH ST S, WISCONSIN RAPIDS, WI 54494 04/01/014 0/1/016 1 COMPASS COUNSELING WAUSAU, LLC, 86 S. SUPERIOR ST., STE 109, ANTIGO, WI 54409 04/0/015 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 5910 09/19/014 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 54401 Marathon County Surveyor: Polly Wong Lic #: 49 MICHAEL DIX Initial Cert: 0/01/001 dgcounseling@outlook.com Phone: (715) 675-888 0/01/014 01/1/016 Fax: (715) 675-988 0/01/014 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 elmer5440@yahoo.com Phone: (715) 845-7175 11/01/01 10/1/015 Fax: (715) 845-714 11/01/01 10/1/015 11/01/01 10/1/015 ELMERGREEN ASSOCIATES, INC, 607 E ELIZABETH STREET, SHAWANO, WI 54166 11/01/01 10/1/015 MILWAUKEE HEALTH SERVICES SYSTEMS DBA WAUSAU HEALTH SERVICES Lic #: 408 09 W WASHINGTON STREET WAUSAU, WI 5440 Marathon County Surveyor: Polly Wong NANCY ELLIS Initial Cert: 01/1/00 nellis@crchealth.com Phone: (715) 845-67 1/01/014 10/1/016 Fax: (715) 845-1977 CSAS-DAY TREATMENT DHS 75.1 CSAS-NARCOTIC TREATMENT DHS 75.15 1/01/014 10/1/016 1/01/014 10/1/016 1/01/014 10/1/016 09/9/015 Page 5 of 1

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 adassow@norcen.org Phone: (715) 848-4600 0/01/015 0/8/017 Fax: (715) 845-6050 CSAS-AMBULATORY DETOXIFICATION DHS 75.08 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-EMERGENCY SERVICE DHS 4. MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 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 54409 0/01/015 0/8/017 MERRILL CENTER, 607 N SALES STREET, #09, MERRILL, WI 5445 0/01/015 0/8/017 TOMAHAWK OFFICE, 1 WEST WISCONSIN AVE, TOMAHAWK, WI 54487 0/01/015 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 ehuffman@norcen.org Phone: (715) 848-4 01/01/015 1/1/016 Fax: (715) 841-5146 CCS REGIONAL MODEL UNIFIED BOARD DHS 6 01/01/015 1/1/016 NORTH CENTRAL HEALTH CARE - LANGLADE COUNTY, 15 LANGLADE ROAD, ANTIGO, WI 54409 01/01/015 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 Lee@peacefulsolutions.org Phone: (715) 675-458 0/01/014 0/9/016 Fax: (715) 675-78 0/01/014 0/9/016 0/01/014 0/9/016 1 PEACEFUL SOLUTIONS COUNSELING, 76 EAST ND STREET, MERRILL, WI 5445 0/01/014 0/9/016 EDGAR MIDDLE/HIGH SCHOOL, 0 E. BIRCH STREET, EDGAR, WI 5446 0/5/015 0/9/016 09/9/015 Page 54 of 1

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 noreen.salzman@hotmail.com Phone: (715) 848-50 09/01/015 08/1/017 Fax: (888) 778-6750 09/01/015 08/1/017 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 1415 EAGLE STREET, RHINELANDER, WI 54501 09/01/015 08/1/017 1 THE CENTRE FOR WELL BEING, 01 N CENTER AVE, MERRILL, WI 5445 09/01/015 08/1/017 LAC DU FLAMBEAU ELEMENTARY SCHOOL, 899 HWY 47, LAC DU FLAMBEAU, WI 5458 09/01/015 08/1/017 Marinette County MARINETTE COUNTY HEALTH & HUMAN SERVICES CCS Lic #: 966 500 HALL AVENUE SUITE B MARINETTE, WI 5414 Marinette County JESSICA BEAUCHAMP Initial Cert: 08/01/01 Phone: (715) 7-7700 08/01/015 07/1/016 Fax: (715) 7-7667 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 #: 1559 500 HALL AVENUE MARINETTE, WI 5414 Marinette County ROBERT VALENTINE Initial Cert: 01/01/198 rvalentine@marinettecounty.com Phone: (715) 7-7760 1/01/01 11/0/015 Fax: (715) 7-7711 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54151 1/01/01 11/0/015 ST. JOSEPH'S HOSPITAL - HOSPITAL SISTERS -THIRD ORDER OF ST FRANCIS DBA LIBERTAS Lic #: 11 171 DUNLAP SQUARE BLDG, #5 MARINETTE, WI 5414 Marinette County BARBARA CONIFF Initial Cert: 05/18/1999 barbara.coniff@hshs.org Phone: (715) 75-0095 06/01/014 05/1/016 Fax: (715) 75-0094 06/01/014 05/1/016 09/9/015 Page 55 of 1

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 tkufahl@ccmadison.org Phone: (608) 97-181 05/01/014 04/0/016 Fax: (608) 97-148 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 05/01/014 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 amyz@co.menominee.wi.us Phone: (715) 799-861 05/01/015 04/0/017 Fax: (715) 799-517 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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

REACH, INC. COMPREHENSIVE MENTAL HEALTH CLINIC Lic #: 88 4550 W BRADLEY ROAD BROWN DEER, WI 5 CANDICE LIPSKI Initial Cert: 09/01/009 reachmentalhealthclinic@hotmail.co Phone: (414) 961-1600 09/01/014 08/1/016 Fax: (414) 961-1616 09/01/014 08/1/016 09/01/014 08/1/016 ROGERS MEMORIAL HOSPITAL - CHILD & ADOLESCENT DAY TREATMENT Lic #: 5 4555 W SCHROEDER DRIVE BROWN DEER, WI 5 Surveyor: Merrilee Follensbee JESSICA PITRE Initial Cert: 07/1/004 jpitre@rogershospital.org Phone: (414) 55-9000 07/01/015 06/0/017 Fax: (414) 55-9665 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 61.75 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 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) 865-500 04/8/015 0/1/016 Fax: (6) 646-10 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 04/8/015 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 #: 1867 5900 S. LAKE DRIVE CUDAHY, WI 5110 NORMAN SHANKS Initial Cert: 11/01/1989 Norman.shanks@aurora.org Phone: (414) 489-415 10/01/014 09/0/016 Fax: (414) 489-4056 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/014 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

AURORA BEHAVIORAL HEALTH - FRANKLIN 900 W. LOOMIS ROAD, #17 FRANKLIN, WI 51 Lic #: 1650 KATHERINE CONNELLY Initial Cert: 05/0/1994 Kate.Connelly@aurora.org Phone: (414) 454-6506 05/01/015 04/0/017 Fax: (414) 454-6450 05/01/015 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 lgodec@shorehavenbhi.com Phone: (414) 540-170 07/01/014 06/0/016 Fax: (414) 540-171 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 515 07/01/014 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 5188 06/01/015 06/0/016 SHOREHAVEN BEHAVIORAL HEALTH, INC., 6 DURAND AVE #F, RACINE, WI 5406 07/01/014 06/0/016 CEDAR CREEK FAMILY COUNSELING, INC. 9910 WEST LAYTON AVE SUITE GREENFIELD, WI 58 Lic #: 1145 BUCKLEY MEADE Initial Cert: 09/15/199 cedrcoun@execpc.com Phone: (414) 47-4884 10/01/01 09/0/015 Fax: (414) 47-4889 10/01/01 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 johnl@serenityrecoveryclinic.com Phone: (414) 76-7751 05/08/015 04/0/016 Fax: (414) 76-7755 05/08/015 04/0/016 1 SERENITY RECOVERY CLINIC LLC, 401 WEST NORTH WATER STREET #0, NEW LONDON, WI 54961 05/08/015 04/0/016 09/9/015 Page 58 of 1

ND CENTURY 187 S 85TH STREET MILWAUKEE, WI 57 Lic #: 68 DAWN ROLLING Initial Cert: 08/0/006 Dawn@hhcppo.com Phone: (414) 1-596 0/01/014 01/1/016 Fax: (414) 1-595 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/014 01/1/016 A STRONG FOUNDATION COUNSELING SERVICES, LLC Lic #: 98 4447 N OAKLAND AVENUE MILWAUKEE, WI 511 NEAOKIA COLLINS Initial Cert: 11/06/01 ncollins@astrongfoundationss.org Phone: (414) 967-7990 1/01/014 10/1/015 Fax: (414) 967-7991 CSAS-DAY TREATMENT DHS 75.1 1/01/014 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 afreund@amhclinic.com Phone: (414) 871-9111 08/01/015 07/1/017 Fax: (414) 871-911 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 507 08/01/015 07/1/017 1 ACACIA MENTAL HEALTH CLINIC, LLC, 6040 WEST LISBON AVE STE #10, MILWAUKEE, WI 507 08/01/015 07/1/017 ACHIEVEMENT ASSOCIATES, LTD. 11040 WEST BLUEMOUND RD MILWAUKEE, WI 56 Lic #: 1010 NEENA FLORSHEIM Initial Cert: 07/01/199 AALTEAM@aol.com Phone: (6) 41-5099 06/01/015 05/1/017 Fax: (6) 41-5054 06/01/015 05/1/017 06/01/015 05/1/017 09/9/015 Page 59 of 1

AIDS RESOURCE CENTER OF WISCONSIN 80 N. PLANKINTON AVENUE MILWAUKEE, WI 50 Lic #: 406 KEVIN ROEDER Initial Cert: 10/0/00 Kevin.Roeder@arcw.org Phone: (414) 5-1540 01/01/015 1/0/016 Fax: (414) 5-168 CSAS-DAY TREATMENT DHS 75.1 01/01/015 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 5140 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-LA CROSSE, 505 KING STREET, LA CROSSE, WI 54601 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WISCONSIN, 6 C WEST WISCONSIN AVE, APPLETON, WI 54911 01/01/015 1/0/016 1 AIDS RESOURCE CENTER OF WI-WAUSAU, 1105 GRAND AVENUE, #1, WAUSAU, WI 5440 01/01/015 1/0/016 1 AIDS RESOURCE ENTER OF WI-EAU CLAIRE, 505 DEWEY STREET SOUTH, #107, EAU CLAIRE, WI 547 01/01/015 1/0/016 1 ARCW, 16 W. GRAND AVENUE, BELOIT, WI 5511 0/01/015 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 5401 01/01/015 1/0/016 AMRI COUNSELING SERVICES, LLC 4001 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 875 LAKEIA JONES Initial Cert: 08/01/009 amricounseling@yahoo.com Phone: (414) 810-6691 08/01/014 07/1/016 Fax: (866) 719-04 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 08/01/014 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 514 08/9/014 07/1/016 ARC MILWAUKEE WOMEN'S PROGRAM 10 W MADISON STREET MILWAUKEE, WI 504 Lic #: 069 ROBIN RYAN Initial Cert: 1/11/014 rryan@arccommserv.com Phone: (414) 87-6054 1/11/014 11/0/015 Fax: (414) 87-606 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 1/11/014 11/0/015 09/9/015 Page 60 of 1

AURORA BEHAVIORAL HEALTH - NORTH SHORE Lic #: 15 6980 N. PORT WASHINGTON, #0 MILWAUKEE, WI 517 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 08/01/1985 kate.connelly@aurora.org Phone: (414) 454-6506 08/01/014 07/1/016 Fax: (414) 454-6450 08/01/014 07/1/016 08/01/014 07/1/016 1 AURORA BEHAVIORAL HEALTH - HARTFORD, 1640 E SUMNER STREET, HARTFORD, WI 507 08/01/014 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 5095 08/01/014 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 kate.connelly@aurora.org Phone: (414) 454-6506 01/01/014 1/1/015 Fax: (414) 454-6450 01/01/014 1/1/015 01/01/014 1/1/015 BENEDICT CENTER WOMEN'S HARM REDUCTION PROGRAM Lic #: 456 15 W WELLS STREET, #700 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee MEAGAN WINN Initial Cert: 01/15/00 justice@benedictcenter.org Phone: (414) 47-1774 01/01/014 1/1/015 Fax: (414) 47-0148 01/01/014 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 cydoutpatient@yahoo.com Phone: (414) 6-85 06/01/015 05/1/016 Fax: (414) 64-64 CSAS-DAY TREATMENT DHS 75.1 06/01/015 05/1/016 06/01/015 05/1/016 06/01/015 05/1/016 09/9/015 Page 61 of 1

CENTER FOR QUALITY COMMUNITY LIFE, INC. (CQCL) Lic #: 969 680 W VILLARD AVENUE, #00 MILWAUKEE, WI 518 KATHY CARTER Initial Cert: 08/01/01 Kcarter@cqcl.org Phone: (414) 464-0578 08/01/014 07/1/016 Fax: (414) 464-115 CSAS-DAY TREATMENT DHS 75.1 08/01/014 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) 9-0090 09/01/01 08/1/015 Fax: (866) 440-0779 CSAS-DAY TREATMENT DHS 75.1 09/01/01 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 wfry@columbia-stmarys.org Phone: (414) 91-160 01/01/014 1/1/015 Fax: (414) 91-1969 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 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 COLUMBIA ST. MARY'S HOSPITAL MILWAUKEE CAMPUS Lic #: 115 01 N LAKE DRIVE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee WILLIAM L. FRY Initial Cert: 07/01/015 wfry@columbia-stmarys.org Phone: (414) 91-550 07/01/015 06/0/016 Fax: (414) 91-551 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/015 06/0/016 07/01/015 06/0/016 09/9/015 Page 6 of 1

EBB TIDE THERAPY 81 N 4TH STREET RM 144 MILWAUKEE, WI 51 Lic #: 956 SHANNON O'BRIEN Initial Cert: 0/01/01 ebbtidetherapy@att.net Phone: (414) 7-71 0/01/015 01/1/017 Fax: (414) 7-71 0/01/015 01/1/017 0/01/015 01/1/017 EMPATHETIC COUNSELING SERVICES INC. 5501 W BURLEIGH ST MILWAUKEE, WI 510 Lic #: 95 TANYA BROUGHTON LEWIS Initial Cert: 1/01/011 empatheticcounseling@gmail.com Phone: (414) 88-5617 1/01/014 11/0/016 Fax: (414) -5 CSAS-DAY TREATMENT DHS 75.1 1/01/014 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 fokusfamilyservices@yahoo.com Phone: (414) 64-417 04/01/014 0/9/016 Fax: (414) 64-418 CSAS-DAY TREATMENT DHS 75.1 04/01/014 0/8/015 04/01/014 0/9/016 04/01/014 0/9/016 FOREVER FREE SUBSTANCE ABUSE & MENTAL HEALTH TREATMENT CENTER Lic #: 059 74 S LAYTON BLVD MILWAUKEE, WI 515 DR. CHARLES GREEN Initial Cert: 11/1/014 wor_cgreen@hotmail.com Phone: (414) 8-85 11/1/014 10/1/015 Fax: CSAS-DAY TREATMENT DHS 75.1 11/1/014 10/1/015 11/1/014 10/1/015 09/9/015 Page 6 of 1

GATEWAY TO CHANGE 19 W. CAPITOL DRIVE MILWAUKEE, WI 506 Lic #: 479 GLENDA HAMPTON Initial Cert: 10/9/00 gatewaytochange19@gmail.com Phone: (414) 44-0 1/01/014 11/0/016 Fax: (414) 44-167 CSAS-DAY TREATMENT DHS 75.1 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 GENESIS BEHAVIORAL SERVICES, INC. MEN'S AODA RESIDENTIAL Lic #: 18 46 N. 50TH STREET MILWAUKEE, WI 510 GINA SINGLETERY Initial Cert: 07/15/199 gina.singletery@corizonhealth.com Phone: (414) 44-5990 08/01/014 07/1/016 Fax: (414) 449-99 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/014 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 Gina.Singletery@CorizonHealth.com Phone: (414) 44-406 1/01/014 11/0/015 Fax: (414) 44-0107 CSAS-DAY TREATMENT DHS 75.1 1/01/014 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 gina.singletery@corizonhealth.com Phone: (414) 777-1570 06/01/015 05/1/017 Fax: (414) 777-1565 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 06/01/015 05/1/017 09/9/015 Page 64 of 1

GRO FAMILY SERVICES 6400 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 80 GREGORY OWENS Initial Cert: 08/8/008 acc_gro@yahoo.com Phone: (414) 445-1400 08/01/015 07/1/017 Fax: (414) 95-4716 CSAS-DAY TREATMENT DHS 75.1 08/01/015 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 506 08/01/015 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 kristen@guesthouseofmilwaukee.or Phone: (414) 45-40 08/01/015 07/1/017 Fax: (414) 45-58 08/01/015 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 Emily@hhcppo.com Phone: (414) 76-549 01/1/014 10/1/015 Fax: (414) 76-977 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 510 01/1/014 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 icbs014@yahoo.com Phone: (414) 49-574 04/01/015 0/1/016 Fax: (414) 49-876 04/01/015 0/1/016 04/01/015 0/1/016 09/9/015 Page 65 of 1

KIDS IN TRANSITION, INC 81 NORTH 4TH STREET STE #08 MILWAUKEE, WI 51 Lic #: 607 CLEON SUGGS Initial Cert: 10/9/01 transitionin1@yahoo.com Phone: (414) 688-06 07/17/015 06/0/016 Fax: (414) 77-898 07/17/015 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 chyrat@lacausa.org Phone: (414) 90-1500 05/01/015 04/0/017 Fax: (414) 771-7497 05/01/015 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 arthur.kennedy@ymail.com Phone: (414) 79-17 07/01/015 06/0/016 Fax: (414) 540-9750 CSAS-DAY TREATMENT DHS 75.1 07/01/015 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 olockett@wi.rr.com Phone: (414) 89-8994 08/01/015 07/1/016 Fax: (414) -07 CSAS-DAY TREATMENT DHS 75.1 08/01/015 07/1/016 08/01/015 07/1/016 08/01/015 07/1/016 09/9/015 Page 66 of 1

M & S CLINICAL SERVICES, INC. 81 NORTH 4TH ST #516 MILWAUKEE, WI 51 Lic #: 1546 MARK FOSSIE Initial Cert: 1/04/1996 fossiem@sbcglobal.net Phone: (414) 6-6000 04/01/015 0/8/017 Fax: (414) 6-70 04/01/015 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 antoneod@mtrcinc.org Phone: (414) 4-5474 0/01/015 0/8/017 Fax: (414) 4-5476 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/015 0/8/017 MATT TALBOT RECOVERY SERVICES INC (FIRST STEP COMMUNITY RECOVERY CTR) Lic #: 07 85 N ND STREET MILWAUKEE, WI 510 DARREN MATAVKA Initial Cert: 0/05/015 darren@hhcppo.com Phone: (414) 79-896 0/05/015 01/1/016 Fax: (414) 01-68 CSAS-AMBULATORY DETOXIFICATION DHS 75.08 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 0/05/015 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 tinawilliamsanford@att.net Phone: (414) 788-6 01/01/015 1/1/015 Fax: (414) 9-049 CSAS-DAY TREATMENT DHS 75.1 01/01/015 1/1/015 01/01/015 1/1/015 01/01/015 1/1/015 09/9/015 Page 67 of 1

MCW DEPARTMENT OF PSYCHIATRY CLINICS AT TOSA Lic #: 1580 1155 N MAYFAIR ROAD MILWAUKEE, WI 56 JEFFREY G MILLER Initial Cert: 07/01/1996 jgmiller@mcw.edu Phone: (414) 955-8900 0/01/015 01/1/017 Fax: (414) 955-685 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 mdtherapybh@aol.com Phone: (414) 466-04 01/01/015 05/1/016 Fax: (414) 466-06 01/01/015 05/1/016 01/01/015 05/1/016 META HOUSE, INC (SHOREWOOD CAMPUS) AKA META III Lic #: 1619 94-6 N. MARYLAND AVENUE MILWAUKEE, WI 511 Surveyor: Merrilee Follensbee CHRISTINE ULLSTRUP Initial Cert: 0/01/1995 cullstrup@metahouse.org Phone: (414) 96-100 0/01/015 01/1/017 Fax: (414) 96-05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/015 01/1/017 0/01/015 01/1/017 META HOUSE, INC (SOUTH CAMPUS) AKA RIVERWEST Lic #: 0 618 N. BREMEN STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee CHRISTINE ULLSTRUP Initial Cert: 05/0/1998 mail@metahouse.org Phone: (414) 96-100 0/01/015 01/1/017 Fax: (414) 96-05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/015 01/1/017 0/01/015 01/1/017 09/9/015 Page 68 of 1

META HOUSE, INC. 65 N WEIL STREET MILWAUKEE, WI 51 Surveyor: Merrilee Follensbee Lic #: 17 CHRISTINE ULLSTRUP Initial Cert: 11/4/1999 cullstrup@metahouse.org Phone: (414) 96-100 1/01/01 11/0/015 Fax: (414) 96-05 CSAS-DAY TREATMENT DHS 75.1 1/01/01 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 cullstrup@metahouse.org Phone: (414) 96-100 08/01/015 07/1/017 Fax: (414) 96-05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/015 07/1/017 08/01/015 07/1/017 MILWAUKEE CENTER FOR INDEPENDENCE DBA TLS BEHAVIORAL HEALTH Lic #: 19 1040 S. 70TH STREET MILWAUKEE, WI 514 TIM MCGUIRE Initial Cert: 09/01/1985 timothy.mcguire@mfci.net Phone: (414) 476-9675 06/01/015 05/1/017 Fax: (414) 615-067 06/01/015 05/1/017 06/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 057 S 14TH STREET, MILWAUKEE, WI 504 06/01/015 05/1/017 1 CRISIS RESOURCE CENTER, 5409 W VILLARD AVE, MILWAUKEE, WI 518 06/01/015 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 507 06/01/015 05/1/017 1 TRANSITIONAL LIVING SERVICES INC, 710 DOUGLAS AVENUE, RACINE, WI 540 06/01/015 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

MILWAUKEE COUNTY COMPREHENSIVE COMMUNITY SERVICES PROGRAM Lic #: 07 901 WEST WATERTOWN PLANK ROAD MILWAUKEE, WI 56 AMY LORENZ Initial Cert: 09/01/014 Phone: (414) 57-8085 09/01/015 08/1/016 Fax: CCS REGIONAL MODEL POPULATION-BASED DHS 6 1 ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, SC, 10045 W LISBON AVENUE, MILWAUKEE, WI 1 BELL THERAPY, INC, 4065 N 5TH STREET, MILWAUKEE, WI 518 1 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 514 1 OUTREACH COMMUNITY HEALTH CENTERS, INC, 711 W CAPITOL DRIVE, MILWAUKEE, WI 506 1 ST CHARLES YOUTH & FAMILY SERVICES, INC, 4757 N 76TH STREET, MILWAUKEE, WI 518 1 THE GUEST HOUSE OF MILWAUKEE, 116 N 1TH STREET, MILWAUKEE, WI 505 1 WISCONSIN COMMUNITY SERVICES, 7 W WISCONSIN AVE. SUITE 00, MILWAUKEE, WI 508 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 09/01/018 08/1/016 MILWAUKEE HEALTH SERVICE SYSTEMS DBA RIVER'S SHORE CLINIC Lic #: 164 707 N RICHARDS STREET MILWAUKEE, WI 51 KIVAUGHN SHELTON Initial Cert: 11/01/1986 kshelton@crchealth.com Phone: (414) 967-7006 08/01/015 07/1/017 Fax: (414) 967-700 CSAS-NARCOTIC TREATMENT DHS 75.15 08/01/015 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 lcrane@crchealth.com Phone: (414) 744-570 05/01/015 04/0/016 Fax: (414) 744-905 CSAS-NARCOTIC TREATMENT DHS 75.15 05/01/015 04/0/016 05/01/015 04/0/016 MULTI-CULTURAL COUNSELING SERVICES II INC, DBA RENEW COUNSELING SERVICES Lic #: 01 6815 W CAPITOL DR SUITE #105 MILWAUKEE, WI 504 WAYNE CROATT Initial Cert: 1/01/01 renewcounseling1@sbcglobal.net Phone: (414) 8-4455 1/01/014 11/0/016 Fax: (414) 77-870 1/01/014 11/0/016 1/01/014 11/0/016 09/9/015 Page 70 of 1

MWCCA BEHAVIORAL HEALTH CLINIC 78 NORTH JAMES LOVELL ST MILWAUKEE, WI 5 Lic #: 1794 LATRICE BUCK HOGAN Initial Cert: 0/01/1988 lbhogan@communityadvocates.net Phone: (414) 70-6941 07/01/014 06/0/016 Fax: (414) 70-971 CSAS-DAY TREATMENT DHS 75.1 07/01/014 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 leola_wllms@newchoicesllc.net Phone: (414) 444-8445 10/01/015 09/0/017 Fax: (414) 444-84 CSAS-DAY TREATMENT DHS 75.1 10/01/015 09/0/017 10/01/015 09/0/017 10/01/015 09/0/017 NEW LIFE COUNSELING & FAMILY SOCIAL SERVICE AGENCY, INC. Lic #: 068 144 N FARWELL, SUITE 00 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THERESA ANTHONY Initial Cert: 1/01/014 tanthony11@aol.com Phone: (414) 15-8477 1/01/014 11/0/015 Fax: (866) 440-0779 CSAS-DAY TREATMENT DHS 75.1 1/01/014 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 tripp-barbara@sbcglobal.net Phone: (414) 1-8910 04/01/015 0/1/017 Fax: (414) 455-9 04/01/015 0/1/017 04/01/015 0/1/017 09/9/015 Page 71 of 1

OUTREACH COMMUNITY HEALTH CENTERS INC 10 W CAPITOL DRIVE MILWAUKEE, WI 51 Lic #: 46 ANGELA SANDERS Initial Cert: 08/01/000 angelas@orchc-milw.org Phone: (414) 74-400 08/01/014 07/1/016 Fax: (414) 77-61 08/01/014 07/1/016 08/01/014 07/1/016 OUTREACH COMMUNITY HEALTH CENTER, 711 W CAPITOL DRIVE, MILWAUKEE, WI 506 08/01/014 07/1/016 PARADIGM ENRICHMENT SERVICES, INC. 6110 WEST CAPITOL DRIVE MILWAUKEE, WI 516 Lic #: 990 FREDERICK G. JACKSON, II Initial Cert: 0/5/01 fgjackson@gmail.com Phone: (414) 9-1156 0/01/015 0/8/017 Fax: (414) 9-1155 CSAS-DAY TREATMENT DHS 75.1 0/01/015 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 Positiveoutlook006@yahoo.com Phone: (414) 460-6995 08/01/014 07/1/016 Fax: (414) 55-5467 CSAS-DAY TREATMENT DHS 75.1 08/01/014 07/1/016 08/01/014 07/1/016 08/01/014 07/1/016 PROFESSIONAL READJUSTMENT OUTREACH CONSULTANT GROUP Lic #: 989 4 WEST CAPITOL DRIVE STE LL MILWAUKEE, WI 516 CARLA WILLIAMS Initial Cert: 01/16/01 cbeam99@wi.rr.com Phone: (414) 810-441 04/01/015 0/1/016 Fax: (414) 810-441 CSAS-DAY TREATMENT DHS 75.1 04/01/015 0/1/016 04/01/015 0/1/016 04/01/015 0/1/016 09/9/015 Page 7 of 1

RAVENSWOOD CLINIC 66 N. PROSPECT AVENUE, #6 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee Lic #: 118 ANTHONY F. WERTH, JR. Initial Cert: 06//1999 awerth@ravenswoodclinic.org Phone: (414) 4-049 09/01/015 08/1/017 Fax: (414) 4-811 CSAS-DAY TREATMENT DHS 75.1 09/01/015 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 renewcounseling1@sbcglobal.net Phone: (414) 8-4455 09/01/015 08/1/017 Fax: (414) 77-870 09/01/015 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 jeremy.a.jaeger@gmail.com Phone: (414) 7-8484 07/01/015 06/0/017 Fax: (414) 446-17 CSAS-DAY TREATMENT DHS 75.1 07/01/015 06/0/017 07/01/015 06/0/017 SEBASTIAN FAMILY PSYCHOLOGY PRACTICE LLC Lic #: 495 170 W FLORIST AVENUE #15 MILWAUKEE, WI 509 Surveyor: Merrilee Follensbee SEBASTIAN SSEMPIJJA Initial Cert: 01/14/004 sssempijja@sbcglobal.net Phone: (414) 47-0801 01/01/015 1/1/016 Fax: (414) 47-0816 CSAS-DAY TREATMENT DHS 75.1 04/01/015 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

SHECAR SUBSTANCE ABUSE/MENTAL HEALTH OUTPATIENT TREATMENT CENTER, LLC Lic #: 945 81 N 4TH STREET, #08 MILWAUKEE, WI 51 SHEILA R RAMOS Initial Cert: 06/7/011 shecar0@yahoo.com Phone: (414) 7-90 09/01/015 08/1/017 Fax: (414) 7-964 CSAS-DAY TREATMENT DHS 75.1 09/01/015 08/1/017 09/01/015 08/1/017 09/01/015 08/1/017 SOCIAL DEVELOPMENT COMMISSION YOUTH & FAMILY DEVELOPMENT PROGRAM Lic #: 7 4041 N. RICHARDS STREET MILWAUKEE, WI 51 ELLA DUNBAR Initial Cert: 04/9/00 edunbar@cr-sdc.org Phone: (414) 906-704 05/01/014 04/0/016 Fax: (414) 96-691 05/01/014 04/0/016 05/01/014 04/0/016 ST. CHARLES YOUTH & FAMILY SERVICES - FAMILY DEVELOPMENT CENTER Lic #: 1 4757 N. 76TH STREET MILWAUKEE, WI 518 GLYNIS UNDERWOOD Initial Cert: 01/01/1991 referrals@stcharlesinc.org Phone: (414) 58-415 0/01/015 01/1/017 Fax: (414) 58-5005 0/01/015 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 #: 690 900 W OKLAHOMA AVENUE MILWAUKEE, WI 515 KATE CONNELLY Initial Cert: 08/0/006 kate.connelly@aurora.org Phone: (414) 489-4094 09/01/015 08/1/017 Fax: (414) 454-6450 09/01/015 08/1/017 09/01/015 08/1/017 09/9/015 Page 74 of 1

ST. ROSE YOUTH & FAMILY CENTER 801 N. 88TH STREET MILWAUKEE, WI 5 Surveyor: Merrilee Follensbee Lic #: 1876 JESSICA WALDRON Initial Cert: 07/05/1985 jessicawaldron@ladlake.org Phone: (414) 466-9450 09/01/014 08/1/016 Fax: (414) 466-070 09/01/014 08/1/016 09/01/014 08/1/016 1 LAD LAKE, INC. DOUSMAN, W50 - S1401 WATERVILLE ROAD, DOUSMAN, WI 5118 07/8/015 08/1/016 THE BRIDGE HEALTH CLINICS & RESEARCH CENTERS Lic #: 91 600 W WALNUT STREET, SUITE -R MILWAUKEE, WI 51 TODD CAMPBELL Initial Cert: 08/19/010 toddcampbell@thebridgehealthclinic Phone: (414) 81-4500 08/01/015 07/1/017 Fax: (414) 55-451 CSAS-DAY TREATMENT DHS 75.1 08/01/015 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 #: 944 81 N 4TH STREET SUITE 145 MILWAUKEE, WI 51 RHONDA ARMON-BENT Initial Cert: 07/01/011 rhonda.armon@gmail.com Phone: (414) 74-8787 01/01/015 1/1/016 Fax: (414) 74-8181 01/01/015 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 juan@unitedcc.org Phone: (414) 84-100 10/01/014 09/0/016 Fax: (414) 647-860 CSAS-DAY TREATMENT DHS 75.1 10/01/014 09/0/016 10/01/014 09/0/016 10/01/014 09/0/016 09/9/015 Page 75 of 1

UNITED COMMUNITY CENTER 604 W SCOTT STREET MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee Lic #: 881 JUAN A. RUIZ Initial Cert: 08/1/009 juan@unitedcc.org Phone: (414) 64-850 08/01/014 07/1/016 Fax: (414) 647-860 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 08/01/014 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 juanr@unitedcc.org Phone: (414) 64-850 04/01/015 0/1/017 Fax: (414) 647-860 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/015 0/1/017 04/01/015 0/1/017 WCS-MILWAUKEE COUNTY DAY REPORTING CENTER Lic #: 05 167 S 9TH ST, BASEMENT MILWAUKEE, WI 504 Surveyor: Merrilee Follensbee JOY FITZSIMONS Initial Cert: 10/01/014 jfitzsimons@wiscs.org Phone: (414) 9-1516 10/01/015 09/0/017 Fax: (414) 4-8847 10/01/015 09/0/017 WHEATON FRANCISCAN BEHAVIORAL HEALTH ST. FRANCIS HOSPITAL Lic #: 547 7 S 16TH STREET #00 MILWAUKEE, WI 515 BARBARA JONES Initial Cert: 10/7/004 Barbara.Jones@wfhc.org Phone: (414) 89-111 11/01/01 10/1/015 Fax: (414) 89-110 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/01 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

WHEATON FRANCISCAN BEHAVIORAL HEALTH - ST. JOSEPH REGIONAL MEDICAL CENTER Lic #: 548 5000 W CHAMBERS ST #P10 MILWAUKEE, WI 510 CAROL HESS Initial Cert: 10/7/004 carol.hess@wfhc.org Phone: (414) 874-1171 11/01/01 10/1/015 Fax: (414) 874-1177 11/01/01 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 smaloney@phoenixcaresystems.com Phone: (414) 445-9180 08/01/014 07/1/016 Fax: (414) 57-6971 08/01/014 07/1/016 08/01/014 07/1/016 1 WILLOWGLEN ACADEMY - CSP NORTH, 4941 W FOND DU LAC AVE, MILWAUKEE, WI 516 08/01/014 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 509 08/01/014 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 #: 1955 0 W. WELLS STREET, #500 MILWAUKEE, WI 50 Surveyor: Merrilee Follensbee THOMAS CARROLL Initial Cert: 06/01/1986 tcarroll@wiscs.org Phone: (414) 90-0440 10/01/014 09/0/016 Fax: (414) 6-051 CSAS-DAY TREATMENT DHS 75.1 10/01/014 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 lfuller@wohmke.org Phone: (414) 447-1965 0/01/014 0/9/016 Fax: (414) 874-86 CSAS-DAY TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 09/9/015 Page 77 of 1

ALTERNATIVES IN PSYCHOLOGICAL CONSULTATION, S.C. Lic #: 10 10045 W LISBON AVENUE, #1 WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee KAREN DREXLER Initial Cert: 11/0/1997 kdrexler@altlig.com Phone: (414) 58-7144 1/01/01 11/0/015 Fax: (414) 58-7158 1/01/01 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 #: 74 10 N MAYFAIR ROAD, #05 WAUWATOSA, WI 56 Surveyor: Merrilee Follensbee TRISHA WOLLIN Initial Cert: 05/0/007 twollin@appliedtherapiesandwellnes Phone: (414) 0-1 06/01/014 05/1/016 Fax: (414) 0-14 06/01/014 05/1/015 06/01/014 05/1/016 AURORA BEHAVIORAL HEALTH CENTER WAUWATOSA Lic #: 518 10 DEWEY AVENUE WAUWATOSA, WI 51 Surveyor: Merrilee Follensbee KATE CONNELLY Initial Cert: 0/1/004 Kate.Connelly@aurora.org Phone: (414) 454-6506 0/01/015 0/8/017 Fax: (414) 454-6450 0/01/015 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 jamie.surfus-lewiston@aurora.org Phone: (414) 454-6600 08/01/014 07/1/016 Fax: (414) 454-6450 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 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 08/01/014 07/1/016 09/9/015 Page 78 of 1

LUTHERAN COUNSELING AND FAMILY SERVICES OF WISCONSIN Lic #: 1516 800 N. MAYFAIR ROAD WAUWATOSA, WI 5 Surveyor: Merrilee Follensbee CHUCK MESECK Initial Cert: 0/01/1978 lcfs@lcfswi.org Phone: (414) 56-8 04/01/014 0/1/016 Fax: (414) 56-848 04/01/014 0/1/016 04/01/014 0/1/016 1 LCFS-ST JOHN LUTHERAN CHURCH, 4850 S LAKE DRIVE, CUDAHY, WI 5110 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 18 S. PARK AVENUE, NEENAH, WI 54956 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 1614 S. RD STREET, SHEBOYGAN, WI 5081 04/01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 168 MOUND STREET, BERLIN, WI 549 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 10 S. ONEIDA STREET, GREEN BAY, WI 540 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 60 VINCENT ST, FOND DU LAC, WI 5495 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 8 RARITAN, FITCHBURG, WI 5711 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 940 MINERAL POINT RD, JANESVILLE, WI 554 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 00 BROADWAY DRIVE, SUN PRAIRIE, WI 5590 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 4 S. ANDREWS STREET, SHAWANO, WI 5416 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 45 NORTH PINE ST, REEDSBURG, WI 5959 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 701 WASHINGTON ST, GRAFTON, WI 504 04/01/014 0/1/015 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 717 MEMORIAL DRIVE, CHILTON, WI 5014 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 70 JACKSON AVENUE, OMRO, WI 5496 04/01/015 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, 850 ARMSTRONG STREET, PORTAGE, WI 590 04/01/014 0/1/016 1 LUTHERAN COUNSELING & FAMILY SERVICES OF WI, E51 CHURCH ROAD, ALGOMA, WI 5401 04/01/014 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 westgroveclinic@yahoo.com Phone: (414) 810-4844 07/01/014 06/0/016 Fax: (414) 810-4845 07/01/014 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 5045 1/19/014 04/19/015 IMPACT, ALCOHOL AND OTHER DRUG ABUSE SERVICE, INC Lic #: 746 677 W WASHINGTON STREET, #5 WEST ALLIS, WI 514 PATRICIA GUTIERREZ Initial Cert: 08/09/007 pgutierrez@impactinc.org Phone: (414) 56-4808 08/01/014 07/1/016 Fax: (414) 771-4808 CSAS-INTERVENTION DHS 75.16 08/01/014 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

ROGERS MEMORIAL HOSPITAL 448 SOUTH 10ND ST RM #00 WEST ALLIS, WI 57 Lic #: 0 KEITH MOREHOUSE Initial Cert: 05/01/014 kmorehouse@rogershospital.org Phone: (414) 59-000 05/01/014 04/0/016 Fax: (414) 88-78 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 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 05/01/014 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 11101 W. LINCOLN AVENUE WEST ALLIS, WI 57 Surveyor: Merrilee Follensbee Lic #: 14 CATHERINE HENRICKS Initial Cert: 05/01/000 chenricks@rogershospital.org Phone: (414) 7-000 05/01/014 04/0/016 Fax: (414) 7-6045 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 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 QAM - QUALITY ADDICTION MANAGEMENT 1610 MILLER PARKWAY WEST MILWAUKEE, WI 514 Surveyor: Merrilee Follensbee Lic #: 6 CHARLES SCHRAUTH Initial Cert: 06/19/000 cschrauth@qam-inc.com Phone: (414) 67-801 09/01/014 08/1/016 Fax: (414) 67-606 CSAS-NARCOTIC TREATMENT DHS 75.15 09/01/014 08/1/016 09/01/014 08/1/016 09/9/015 Page 80 of 1

Monroe County SCENIC BLUFFS COMMUNITY HEALTH CENTERS Lic #: 804 8 FRONT STREET CASHTON, WI 54619 Monroe County Surveyor: Roderic Senn JESSICA MLSNA Initial Cert: 07/8/008 Phone: (608) 654-5100 07/01/014 06/0/016 Fax: (608) 654-510 07/01/014 06/0/016 07/01/014 06/0/016 MONROE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 1654 1401 HWY B, COMM SVS CTR A-19 SPARTA, WI 54656 Monroe County Surveyor: Roderic Senn TRACY THORSEN Initial Cert: 10/01/1975 Phone: (608) 69-8600 1/01/014 11/0/016 Fax: (608) 69-895 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 1719 501 PARK AVENUE OCONTO, WI 5415 Oconto County BRUCE RETZLAFF Initial Cert: 04/01/1979 bruce.retzlaff@co.oconto.wi.us Phone: (90) 84-7000 09/01/014 08/1/016 Fax: (90) 84-6889 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 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 5414 09/01/014 08/1/016 09/9/015 Page 81 of 1

Oneida County CORNERSTONE PSYCHOLOGICAL ASSOCIATES, LLC Lic #: 977 15 S ONEIDA AVE SUITE 101 RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong THOMAS F. MCGUIRE, LPC Initial Cert: 08/14/01 cornerstoneassociatesllc@gmail.com Phone: (715) 40-101 10/01/015 09/0/017 Fax: (715) 40-10 10/01/015 09/0/017 10/01/015 09/0/017 KOINONIA 1991 WINNEBAGO STREET RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 1469 BRUCE DECORAH Initial Cert: 10/01/1986 bdecorah@optionscs.net Phone: (715) 6-5745 1/01/014 11/0/016 Fax: (715) 6-819 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 1/01/014 11/0/016 1/01/014 11/0/016 1/01/014 11/0/016 09/9/015 Page 8 of 1

OPTIONS COUNSELING SERVICES, LLC 158 SOUTH ANDERSON STREET, SUITE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 74 BRUCE DECORAH Initial Cert: 04/17/007 bdecorah@optionscs.net Phone: (715) 6-5745 05/01/014 0/1/016 Fax: (715) 6-819 05/01/014 0/1/016 05/01/014 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 7 EAST WALL STREET, EAGLE RIVER, WI 5451 05/01/014 0/1/016 1 OPTIONS COUNSELING SERVICES LLC, 944 COUNTY RD J, PO BOX 7, MINOCQUA, WI 54548 05/01/014 0/1/016 OPTIONS COUNSELING SERVICES LLC, 158 SOUTH ANDERSON, SUITE, RHINELANDER, WI 54501 OPTIONS COUNSELING SERVICES LLC, 181 N STEVENS STREET, RHINELANDER, WI 54501 OPTIONS COUNSELING SERVICES LLC, 1991 WINNEBAGO STREET, RHINELANDER, WI 54501 ANTIGO HIGH SCHOOL, 1900 TENTH AVENUE, ANTIGO, WI 54409 ANTIGO MIDDLE SCHOOL, 815 SEVENTH AVENUE, ANTIGO, WI 54409 ARBOR VITAE-WOODRUFF ELEMENTARY SCHOOL, 11065 OLD STATE HWY 51 NORTH, ARBOR VITAE, CENTRAL ELEMENTARY, 418 NORTH PELHAM STREET, RHINELANDER, WI 54501 CRANDON ELEMENTARY/ MIDDLE/HIGH SCHOOL, 9750 US HWY 8 WEST, CRANDON, WI 5450 CRESCENT ELEMENTARY, 19 BOYCE DRIVE, RHINELANDER, WI 54501 CRESTWOOD ELEMENTARY SCHOOL, W8464 CH AA, ANTIGO, WI 54409 EAGLE RIVER ELEMENTARY SCHOOL, 1700 PLEASURE ISLAND RD, EAGLE RIVER, WI 5451 EAST ELEMENTARY SCHOOL, 0 SEVENTH AVENUE, ANTIGO, WI 54409 JAMES WILLIAMS MIDDLE SCHOOL, 915 ACACIA LANE, RHINELANDER, WI 54501 LAKELAND UNION HIGH SCHOOL DISTRICT, 957 STATE HIGHWAY 70, MINOCQUA, WI 54548 LAND O' LAKES ELEMENTARY, 6485 TOWN HALL ROAD, LAND O LAKES, WI 54540 MATTOON ELEMENTARY SCHOOL, 507 STONE AVENUE, MATTOON, WI 54450 NORTH ELEMENTARY SCHOOL, 506 GRAHAM AVENUE, ANTIGO, WI 54409 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 54501 PLEASANT VIEW ELEMENTARY SCHOOL, W11141 CTY RD HH, ANTIGO, WI 54409 RHINELANDER HIGH SCHOOL, 665 COOLIDGE, RHINELANDER, WI 54501 SOAR CHARTER SCHOOL, 6485 TOWN HALL RD, LAND O LAKES, WI 54540 SPRING VALLEY ELEMENTARY, N4754 CTH BB, ANTIGO, WI 54409 ST GERMAIN ELEMENTARY SCHOOL, 84 HWY 70 WEST, SAINT GERMAIN, WI 54558 SUGAR CAMP ELEMENTARY, 4066 CAMP FOUR RD., RHINELANDER, WI 54501 THREE LAKES ELM/JUNIOR & SENIOR HIGH SCHOOL, 690 WEST SCHOOL ST, THREE LAKES, WI 545 WEST ELEMENTARY, 1 SEVENTH AVENUE, ANTIGO, WI 54409 05/01/014 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

ST. MARY'S HOSPITAL MINISTRY KOLLER BEHAVIORAL HEALTH Lic #: 176 100 KABEL AVENUE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong ANDREA STEFONEK Initial Cert: 06/01/1985 andrea.stefonek@ministryhealth.org Phone: (715) 61-805 06/01/014 05/1/016 Fax: (715) 61-90 06/01/014 05/1/016 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER CRANDON, 400 W GLEN STREET, CRANDON, WI 5450 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER EAGLE RIVER, 90 E WALL STREET, EAGLE RIVER, WI 5451 06/01/014 05/1/016 1 ST MARYS HOSP MINISTRY/KOLLER TOMAHAWK, 401 MOHAWK AVE, TOMAHAWK, WI 54487 06/01/014 05/1/016 ST MARYS HOSP MINISTRY/KOLLER WOODRUFF, 11 ELM STREET, WOODRUFF, WI 54568 06/01/014 05/1/016 THE HUMAN SERVICE CENTER 705 EAST TIMBER DRIVE RHINELANDER, WI 54501 Oneida County Surveyor: Polly Wong Lic #: 147 DONNA SHIMECK Initial Cert: 09/01/1980 ds@thehumanservicecenter.org Phone: (715) 69-15 10/01/015 09/0/016 Fax: (715) 69-14 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 54501 Oneida County Surveyor: Polly Wong Lic #: 04 DONNA SHIMECK Initial Cert: 06/7/014 Phone: (715) 69-15 07/01/015 06/0/017 Fax: (715) 69-14 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 54501 Oneida County Surveyor: Polly Wong Lic #: 64 RICHARD MARTIN Initial Cert: 0/01/006 transitionscenter@frontiernet.net Phone: (715) 65-6696 0/01/015 01/1/017 Fax: (715) 65-6768 0/01/015 01/1/017 0/01/015 01/1/017 09/9/015 Page 84 of 1

Outagamie County ACS CLINICAL SERVICES 70 W WASHINGTON STREET APPLETON, WI 5491 Outagamie County Lic #: 608 AMANDA SWAW-WYER Initial Cert: 09/01/005 aswaw-wyer@correctionalservices.o Phone: (90) 80-1750 09/01/014 08/1/016 Fax: (90) 80-1770 09/01/014 08/1/016 ACS CLINICAL SERVICES - MANITOWOC, E WALDO BLVD, MANITOWOC, WI 540 09/01/014 08/1/016 ACS CLINICAL SERVICES - SHEBOYGAN, 151 SOUTH 1TH ST, SHEBOYGAN, WI 5081 09/01/014 08/1/016 CASA CLARE, A DIVISION OF MOORING PROGRAMS, INC. Lic #: 110 01 S GLENRIDGE COURT APPLETON, WI 54914 Outagamie County JAMIE LEOHNIS Initial Cert: 0/1/1996 jamie@mooringcasa.com Phone: (90) 71-981 04/01/015 0/1/017 Fax: (90) 71-85 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 04/01/015 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

CATALPA HEALTH, INC. 444 NORTH WESTHILL BLVD APPLETON, WI 54914 Outagamie County Lic #: 984 GREG BLUME Initial Cert: 11/01/01 greg.blume@catalpahealth.org Phone: (90) 750-7000 11/01/01 10/1/015 Fax: (90) 88-5495 CSAS-PREVENTION DHS 75.04 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 54901 07/01/016 10/1/015 1 CATALPA HEALTH - CASALOMA CAMPUS, 190 N CASALOMA ST, APPLETON, WI 5491 08/14/015 10/1/015 1 CHILD ADVOCACY CENTER, 5 N COMMERCIAL STREET, NEENAH, WI 54956 11/01/01 0/1/014 CATALPA HEALTH ACCESS CENTER, 44 WESTHILL BLVD., APPLETON, WI 54914 CATALPA HEALTH, 181 WITZEL AVE, OSHKOSH, WI 5490 BLACK CREEK ELEMENTARY & MIDDLE SCHOOLS, 08 EAST BURDICK ST, BLACK CREEK, WI 54106 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 54915 HORTONVILLE ELEMENTARY SCHOOL, 40 WARNER ST., HORTONVILLE, WI 54944 HORTONVILLE HIGH SCHOOL, 155 WARNER ST; PO BOX 0, HORTONVILLE, WI 54944 HORTONVILLE MIDDLE SCHOOL, 0 WARNER ST; PO BOX 59, HORTONVILLE, WI 54944 MADISON MIDDLE SCHOOL, 00 S. CARPENTER STREET, APPLETON, WI 54915 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 54901 ROCKLEDGE PRIMARY/INTERMEDIATE CENTERS, 0 WEST HICKORY ST, SEYMOUR, WI 54165 ROOSEVELT MIDDLE SCHOOL, 18 EAST BREWSTER ST, APPLETON, WI 54911 SEYMOUR MIDDLE & HIGH SCHOOLS, 10 CIRCLE DRIVE, SEYMOUR, WI 54165 SHIOCTON PUBLIC SCHOOLS, N5650 BROAD ST, SHIOCTON, WI 54170 WASHINGTON ELEMENTARY SCHOOL, 99 WINNEBAGO AVE, OSHKOSH, WI 54901 WEBSTER STANLEY MIDDLE SCHOOL, 915 HAZEL STREET, OSHKOSH, WI 54901 0/17/014 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

LUTHERAN SOCIAL SERVICES 00 B NORTH RICHMOND ST APPLETON, WI 54911 Outagamie County Lic #: 87 REBECKA HELDT Initial Cert: 06/0/009 rebecka.heldt@lsswis.org Phone: (90) 70-10 09/01/015 08/1/016 Fax: (90) 74-84 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 5490 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 115 NORTH 6TH STREET, WAUSAU, WI 5440 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1500 DOUGLAS DRIVE, PLYMOUTH, WI 507 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 1777 WEST MAIN STREET STE 1, SUN PRAIRIE, WI 5590 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 445 PARK AVENUE, BELOIT, WI 5511 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 706 N 9TH STREET, SHEBOYGAN, WI 5081 09/01/015 08/1/016 1 LUTHERAN SOCIAL SERVICES, 74 SOUTH MAIN ST #10, FOND DU LAC, WI 5495 09/01/015 08/1/016 LUTHERAN SOCIAL SERVICES, 81 N GRANDVIEW BLVD #09, PEWAUKEE, WI 507 LUTHERAN SOCIAL SERVICES, NORTH 5TH STREET EAST, SUPERIOR, WI 54880 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 54914 APPLETON EAST HIGH SCHOOL, 11 NORTH EMMERS DRIVE, APPLETON, WI 54915 APPLETON WEST HIGH SCHOOL, 610 NORTH BADGER AVE, APPLETON, WI 54914 CLOVIS GROVE ELEMENTARY SCHOOL, 974-9TH STREET, MENASHA, WI 5495 LINCOLN ELEMENTARY SCHOOL, 1000 NORTH MASON ST, APPLETON, WI 54914 LSS - NORTHERN LIGHTS ELEMENTARY SCHOOL, 101 NORTH 8TH ST, SUPERIOR, WI 54880 LSS - SUPERIOR HIGH SCHOOL, 600 CATLIN AVE, SUPERIOR, WI 54880 LSS - SUPERIOR MIDDLE SCHOOL, 66 HAMMOND AVE, SUPERIOR, WI 54880 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 54914 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 09/01/015 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 #: 196 01 N BALLARD RD SUITE B APPLETON, WI 54911 Outagamie County JANE WILLIQUETTE Initial Cert: 07/09/1990 Jwilliquette@crchealth.com Phone: (90) 7-444 07/01/015 06/0/017 Fax: (90) 7-4796 CSAS-NARCOTIC TREATMENT DHS 75.15 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 87 of 1

MOORING PROGRAMS, INC. 607 W. SEVENTH STREET APPLETON, WI 54911 Outagamie County Lic #: 1917 JAMIE LOEHNIS Initial Cert: 05/08/1991 Jamie@mooringcasa.com Phone: (90) 79-5 07/01/014 06/0/016 Fax: (90) 71-4796 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 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 OUTAGAMIE CTY HEALTH AND HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVCIES Lic #: 590 401 S ELM STREET APPLETON, WI 54911 Outagamie County JUDY VAN RYZIN Initial Cert: 04/01/005 judy.vanryzin@outagamie.org Phone: (90) 8-570 04/01/015 0/1/017 Fax: (90) 8-5488 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 ST. ELIZABETH HOSPITAL 1506 S. ONEIDA STREET APPLETON, WI 54915 Outagamie County Lic #: 1860 STEVIE REICH Initial Cert: 0/01/1984 sreich@affinityhealth.org Phone: (90) 78-90 11/01/01 10/1/015 Fax: (90) 70-5480 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/01 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 #: 1997 1049 N LYNNDALE DRIVE, #1B APPLETON, WI 54914 Outagamie County DR MYLES TONNACLIFF Initial Cert: 05/01/1990 mtonnacliff@wlcfs.org Phone: (6) 45-555 09/01/014 08/1/016 Fax: (6) 45-551 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 5495 04/7/015 08/1/016 1 WLCFS INC - CHRISTIAN FAMILY COUNSELING, 757 S MAIN STREET, FOND DU LAC, WI 5495 09/01/014 08/1/016 09/9/015 Page 88 of 1

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 joymyersnsc@yahoo.com Phone: (6) 75-1116 08/01/015 07/1/017 Fax: (6) 75-1071 08/01/015 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 5090 08/01/015 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 info@alarushealthcare.com Phone: (6) 77-676 10/01/014 09/0/016 Fax: (6) 77-689 CSAS-DAY TREATMENT DHS 75.1 10/01/014 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 5095 04/06/015 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 AALTEAM@aol.com Phone: (6) 41-5099 06/01/015 05/1/017 Fax: (6) 41-5054 06/01/015 05/1/017 06/01/015 05/1/017 09/9/015 Page 89 of 1

AMERICAN BEHAVIORAL CLINICS 140 W RANCHITO LANE MEQUON, WI 509 Ozaukee County Lic #: 68 JAY SCHRINSKY Initial Cert: 05/01/00 jhschrinsky@gmail.com Phone: (6) 41-1 07/01/014 05/1/016 Fax: (6) 41-411 07/01/014 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 #: 507 1111 N PORT WASHINGTON ROAD MEQUON, WI 5097 Ozaukee County WILLIAM FRY Initial Cert: 09/0/00 wfry@columbia-stmarys.org Phone: (6) 41-617 0/01/014 0/9/016 Fax: (6) 41-61 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 0/01/014 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 #: 187 1111 N PORT WASHINGTON RD MEQUON, WI 5097 Ozaukee County BILL FRY Initial Cert: 09/01/1984 wfry@columbia-stmarys.org Phone: (6) 4-788 0/01/014 0/9/016 Fax: (6) 4-880 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/014 0/9/016 0/01/014 0/9/016 DEPARTMENT OF COMMUNITY PROGRAMS-OZAUKEE COUNTY Lic #: 176 11 W. MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County LIZA DRAKE Initial Cert: 06/01/1977 ldake@co.ozaukee.wi.us Phone: (6) 8-8145 10/01/014 09/0/016 Fax: (6) 8-8104 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5074 08/10/016 09/0/016 09/9/015 Page 90 of 1

OZAUKEE COUNTY CCS PROGRAM 11 W MAIN STREET PORT WASHINGTON, WI 5074 Ozaukee County Lic #: 050 LIZA DRAKE Initial Cert: 09//014 ldrake@co.ozaukee.wi.us Phone: (6) 84-800 10/01/015 09/0/016 Fax: (6) 84-8104 CCS REGIONAL MODEL SHARED SERVICES DHS 6 10/01/015 09/0/016 Pierce County PIERCE COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 177 41 W KINNE STREET ELLSWORTH, WI 54011 Pierce County Surveyor: Roderic Senn RON KIESLER Initial Cert: 1/01/1981 ron.kiesler@co.pierce.wi.us Phone: (715) 7-6770 04/01/015 0/1/017 Fax: (715) 7-686 04/01/015 0/1/017 04/01/015 0/1/017 KINNIC FALLS ALCOHOL AND DRUG ABUSE SERVICES, INC. Lic #: 1468 900 S. ORANGE STREET RIVER FALLS, WI 540 Pierce County Surveyor: Roderic Senn JENNIFER HAGEN Initial Cert: 05/01/1990 Jhagen@kinnicfalls.org Phone: (715) 46-5950 05/01/015 04/0/017 Fax: (715) 46-576 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/015 04/0/017 Polk County POLK COUNTY MENTAL AND BEHAVIORAL HEALTH SERVICES Lic #: 04 100 POLK COUNTY PLAZA #50 BALSAM LAKE, WI 54810 Polk County Surveyor: Roderic Senn KRISTIN BOLAND Initial Cert: 0/08/000 kristin.boland@co.polk.wi.us Phone: (715) 485-8400 05/01/014 04/0/016 Fax: (715) 485-8490 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

Portage County OSWALD COUNSELING ASSOCIATES 450 VINEYARD DRIVE PLOVER, WI 54467 Portage County Surveyor: Hannah Whaley Lic #: 566 LYNNE OSWALD Initial Cert: 01/14/005 ocainc@sbcglobal.net Phone: (715) 4-090 01/01/014 1/1/015 Fax: (715) 4-091 01/01/014 1/1/015 01/01/014 1/1/015 ACS CLINICAL SERVICES, LLC - STEVENS POINT Lic #: 87 440 B CHURCH STREET STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor MARK ROSSANO Initial Cert: 09/15/009 mrossano@acsclinicalservices.org Phone: (715) 95-9618 10/01/014 09/0/016 Fax: (715) 95-961 10/01/014 09/0/016 10/01/014 09/0/016 1 ACS CLINICAL SERVICES LLC - SPARTA, 101 SOUTH WATER STREET, SPARTA, WI 54656 10/01/014 09/0/016 1 ACS CLINICAL SERVICES, LLC - WAUSAU, 90 ND STREET, WAUSAU, WI 5440 10/9/014 09/0/016 1 ACS CLINICAL SERVICES, LLC-SCHOFIELD, 11 SKELLY STREET, SCHOFIELD, WI 54476 10/01/014 10/8/014 MINISTRY BEHAVIORAL HEALTH 01 PRENTICE STREET NORTH STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor Lic #: 116 LAURIE ROBERTS Initial Cert: 10/01/1990 laurie.roberts@ministryhealth.org Phone: (715) 45-0711 07/01/015 06/0/017 Fax: (715) 45-0 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/015 06/0/017 07/01/015 06/0/017 MINISTRY BEHAVIORAL HEALTH 09 PRENTICE STREET NORTH STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor Lic #: 117 LAURIE ROBERTS Initial Cert: 05/01/1991 laurie.roberts@ministryhealth.org Phone: (715) 44-4611 07/01/015 06/0/017 Fax: (715) 44-817 CSAS-DAY TREATMENT DHS 75.1 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 9 of 1

PORTAGE COUNTY HEALTH & HUMAN SERVICES Lic #: 1740 817 WHITING AVENUE STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor AMY MARCOTT Initial Cert: 06/01/1976 marcotta@co.portage.wi.us Phone: (715) 45-5810 04/01/015 0/1/017 Fax: (715) 45-5966 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 #: 71 817 WHITING AVENUE STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor AMY MARCOTT Initial Cert: 0/01/007 marcotta@co.portage.wi.us Phone: (715) 45-5810 0/01/015 0/8/017 Fax: (715) 45-5966 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 0/8/017 RIVERWOOD COUNSELING ASSOCIATES LLC 105 MAIN STREET, #0 STEVENS POINT, WI 54481 Portage County Surveyor: Hannah Whaley Lic #: 0 ROBERT A MILLER Initial Cert: 07/17/000 riverwood_counseling@hotmail.com Phone: (715) 4-556 07/01/014 06/0/016 Fax: (715) 4-5899 07/01/014 06/0/016 07/01/014 06/0/016 SAINT MICHAEL'S HOSPITAL 900 ILLINOIS AVENUE STEVENS POINT, WI 54481 Portage County Surveyor: Erin Taylor Lic #: 180 LAURIE ROBERTS Initial Cert: 05/01/1978 laurie.roberts@ministryhealth.org Phone: (715) 46-5400 10/01/015 09/0/017 Fax: (715) 46-5571 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 10/01/015 09/0/017 10/01/015 09/0/017 09/9/015 Page 9 of 1

Price County COUNSELING AND DEVELOPMENT CENTER, INC. Lic #: 144 171 CHESTNUT STREET PHILLIPS, WI 54555 Price County Surveyor: Polly Wong KELLY J. SCHULTZ Initial Cert: 08/01/198 cdcinc@pctcnet.net Phone: (715) 9-048 08/01/015 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 5455 08/01/015 07/1/017 09/9/015 Page 94 of 1

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 agape1995@att.net Phone: (6) 767-0441 04/01/015 0/1/017 Fax: (6) 767-907 04/01/015 0/1/017 BEHAVIORAL HEALTH SERVICES OF RACINE COUNTY Lic #: 976 1717 TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 08/0/01 michelle.goggins@goracine.org Phone: (6) 68-6744 08/01/015 07/1/017 Fax: (6) 68-6540 CSAS-PREVENTION DHS 75.04 08/01/015 07/1/017 08/01/015 07/1/017 08/01/015 07/1/017 GENESIS BEHAVIORAL SERVICES RACINE OUTPATIENT CLINIC Lic #: 178 1650 WASHINGTON AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/01/1989 gina.singletery@corizonhealth.com Phone: (414) 6-5001 0/01/014 0/9/016 Fax: (414) 6-98 CSAS-DAY TREATMENT DHS 75.1 0/01/014 0/9/016 0/01/014 0/9/016 GENESIS BEHAVIORAL SERVICES, INC. CHATHAM HOUSE Lic #: 777 166 CHATHAM STREET RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 0/01/008 gina.singletery@corizonhealth.com Phone: (6) 67-679 0/01/015 0/8/017 Fax: (6) 67-60 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 0/01/015 0/8/017 0/01/015 0/8/017 09/9/015 Page 95 of 1

GENESIS BEHAVIORAL SERVICES, INC. CROSSROADS Lic #: 180 4107-4109 ST CLAIR STREET RACINE, WI 540 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 09/01/1994 gina.singletery@corizonhealth.com Phone: (6) 6-889 09/01/015 08/1/017 Fax: (6) 6-566 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/015 08/1/017 09/01/015 08/1/017 GENESIS BEHAVIORAL SERVICES, INC. SPRING PLACE Lic #: 70 175 SPRING PLACE RACINE, WI 5404 Racine County Surveyor: William Rohner GINA SINGLETERY Initial Cert: 04/09/007 Gina.Singletery@corizonhealth.com Phone: (6) 6-889 05/01/015 04/0/017 Fax: (6) 6-566 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/015 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 ceo@harvestconsult.com Phone: (6) 60-870 1/01/01 11/0/015 Fax: (6) 60-858 CSAS-AMBULATORY DETOXIFICATION DHS 75.08 1/01/01 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 cschrauth@qam-inc.com Phone: (6) 598-19 09/01/014 08/1/016 Fax: (6) 598-195 CSAS-NARCOTIC TREATMENT DHS 75.15 09/01/014 08/1/016 09/01/014 08/1/016 09/9/015 Page 96 of 1

RACINE COUNTY CCS 1717 TAYLOR AVE RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 01 MICHELLE GOGGINS Initial Cert: 05/08/014 michelle.goggins@goracine.org Phone: (6) 68-66 06/01/015 05/1/017 Fax: (6) 68-6857 CCS REGIONAL MODEL SHARED SERVICES DHS 6 06/01/015 05/1/017 RACINE COUNTY HUMAN SERVICES DEPARTMENT Lic #: 490 1717 TAYLOR AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner MICHELLE GOGGINS Initial Cert: 01/14/004 michelle.goggins@goracine.org Phone: (6) 68-66 01/01/015 1/1/016 Fax: (6) 68-698 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 107 10 WISCONSIN AVENUE RACINE, WI 540 Racine County Surveyor: William Rohner KAREN MOLNAR-SMITH Initial Cert: 07/01/1990 Karen.Molnar-smith@wfhc.org Phone: (6) 687-16 07/01/014 06/0/016 Fax: (6) 687-80 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-INPATIENT DHS 61.71 07/01/014 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 540 01/06/015 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

ZCI-1 54 MAIN STREET, #0 RACINE, WI 540 Racine County Surveyor: William Rohner Lic #: 66 CHERYL ZIMMERMAN, PHD Initial Cert: 01/10/006 ZCI1@ameritech.net Phone: (6) 6-1780 0/01/015 01/1/017 Fax: (6) 6-0895 CSAS-DAY TREATMENT DHS 75.1 0/01/015 01/1/017 0/01/015 01/1/017 Ramsey County (MN) Richland County RICHLAND COUNTY HEALTH & HUMAN SERVICES Lic #: 1797 1 W SEMINARY STREET RICHLAND CENTER, WI 5581 Richland County Surveyor: Cynthia Lindgren KATIE ERB Initial Cert: 01/01/1988 katie.erb@co.richland.wi.us Phone: (608) 647-881 0/01/014 01/1/016 Fax: (608) 647-6611 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 katie.erb@co.richland.wi.us Phone: (608) 647-881 01/01/014 1/1/015 Fax: (608) 647-6611 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

Rock County BELOIT MEMORIAL HOSPITAL-COUNSELING CARE CENTER Lic #: 1100 1969 W. HART ROAD BELOIT, WI 5511 Rock County Surveyor: William Rohner GREG AMMON Initial Cert: 07/01/1985 gammon@beloithealthsystem.org Phone: (608) 64-5686 1/01/014 11/0/016 Fax: (608) 6-5756 1/01/014 11/0/016 1/01/014 11/0/016 1 BELOIT HEALTH SYSTEM, CANCER CENTER, 1670 LEE LANE, BELOIT, WI 5511 1/01/014 11/0/016 1 JANESVILLE OCCUPATIONAL HEALTH, 1409 B CRESTON PARK MALL DRIVE, JANESVILLE, WI 5545 1/01/014 11/0/016 BELOIT MEMORIAL HIGH SCHOOL, 15 4TH STREET, BELOIT, WI 5511 1/01/014 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 wkohlhaas@qam-inc.com Phone: (608) 61-700 10/01/015 09/0/017 Fax: (608) 61-701 CSAS-NARCOTIC TREATMENT DHS 75.15 10/01/015 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 jburns@gencounseling.com Phone: (608) 757-0404 07/01/015 06/0/016 Fax: (608) 757-19 07/01/015 06/0/016 07/01/015 06/0/016 MERCY HEALTH SYSTEM - MERCY OPTIONS WINGS PROGRAM Lic #: 00 90 MINERAL POINT AVENUE JANESVILLE, WI 5548 Rock County Surveyor: William Rohner BELINDA WELLNITZ Initial Cert: 05/18/01 bwellnitz@mhsjvl.org Phone: (608) 756-6545 07/01/015 06/0/017 Fax: (608) 756-6564 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH-DAY TREATMENT DHS 61.75 07/01/015 06/0/017 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 Page 99 of 1

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 lusgaard@mhsjvl.org Phone: (608) 756-6545 07/01/015 06/0/017 Fax: (608) 756-6564 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 07/01/015 06/0/017 07/01/015 06/0/017 MERCY OPTIONS BEHAVIORAL HEALTH CLINIC JANESVILLE Lic #: 1610 90 MINERAL POINT ROAD JANESVILLE, WI 5548 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 01/01/199 lusgaard@mhsjvl.org Phone: (608) 755-470 01/01/014 1/1/015 Fax: (608) 756-0174 01/01/014 1/1/015 01/01/014 1/1/015 1 MERCY MALL CLINIC, 1010 N WASHINGTON, JANESVILLE, WI 5545 01/01/014 1/1/015 1 MERCY CLINIC NORTH, 400 DEERFIELD DRIVE, JANESVILLE, WI 5546 01/01/014 1/1/015 1 MERCY EAST CLINIC, 54 E MILWAUKEE STREET, JANESVILLE, WI 5546 01/01/014 1/1/015 1 MERCY EDGERTON MEDICAL CENTER, 17 N MAIN ST, EDGERTON, WI 554 01/01/014 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 5190 01/01/014 1/1/015 1 MERCY WEST CLINIC, 1000 MINERAL POINT ROAD, JANESVILLE, WI 5545 01/01/014 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 5191 01/01/014 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 #: 741 0 EAST COURT ST JANESVILLE, WI 5547 Rock County Surveyor: William Rohner LISA USGAARD Initial Cert: 07/01/007 lusgaard@mhsjvl.org Phone: (608) 741-117 07/01/015 06/0/017 Fax: (608) 758-5761 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

ROCK COUNTY COMPREHENSIVE COMMUNITY SERVICES Lic #: 00 50 NORTH COUNTY HWY F JANESVILLE, WI 5547 Rock County Surveyor: Cynthia Lindgren KATE FLANAGAN Initial Cert: 07/01/014 flanagan@co.rock.wi.us Phone: (608) 757-5566 07/01/015 06/0/016 Fax: (608) 757-5545 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 554 07/01/015 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 RCHSD@co.rock.wi.us Phone: (608) 757-5850 09/01/014 08/1/016 Fax: (608) 757-5545 09/01/014 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 5546 09/01/015 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 5511 01/7/015 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 aeggers@rvcp.org Phone: (608) 741-4500 0/01/014 0/9/016 Fax: (608) 741-450 0/01/014 0/9/016 0/01/014 0/9/016 JANESVILLE PSYCHIATRIC CLINIC, 15 W. MILWAUKEE ST., #07, JANESVILLE, WI 5546 04/5/015 0/9/016 TRIVIUM DBA CROSSROADS COUNSELING CENTER Lic #: 165 17 S RIVER STREET #54 JANESVILLE, WI 5548 Rock County Surveyor: Cynthia Lindgren TIM PERRY Initial Cert: 09/01/1977 tperry@crossroads7.com Phone: (608) 755-560 10/01/015 09/0/017 Fax: (608) 755-567 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 5590 10/01/015 09/0/017 Rusk County 09/9/015 age 101 of 1

Saint Croix County BURKWOOD TREATMENT CENTER 615 OLD MILL ROAD HUDSON, WI 54016 Saint Croix County Surveyor: Roderic Senn Lic #: 1118 CHARLES BROOKS Initial Cert: 0/01/1988 chbrooks@crchealth.com Phone: (715) 86-615 05/01/014 04/0/016 Fax: (715) 81-0158 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 05/01/014 04/0/016 05/01/014 04/0/016 HUDSON HOSPITAL & CLINICS, PROGRAMS FOR CHANGE Lic #: 117 901 DOMINION DRIVE HUDSON, WI 54016 Saint Croix County Surveyor: Roderic Senn PETER VAN DUSARTZ Initial Cert: 09/01/1990 Peter.J.Vandusartz@HudsonHospita Phone: (715) 51-6755 1/01/01 11/0/015 Fax: (715) 51-6766 1/01/01 11/0/015 06//015 11/0/015 1 HUDSON HOSPITAL AND CLINIC, 411 STAGELINE ROAD, HUDSON, WI 54016 06//015 11/0/015 1 WESTFIELDS HOSPITAL, 55 HOSPITAL ROAD, NEW RICHMOND, WI 54017 1/01/01 11/0/015 ST. CROIX COUNTY HEALTH & HUMAN SERVICES BEHAVIORAL HEALTH Lic #: 1855 175 DORSET LANE NEW RICHMOND, WI 54017 Saint Croix County Surveyor: Roderic Senn STEVE KIRT Initial Cert: 10/01/1975 steve.kirt@co.saint-croix.wi.us Phone: (715) 46-856 1/01/014 11/0/016 Fax: (715) 46-884 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 #: 064 140 E. SUPERIOR STREET DULUTH, MN 55805 Saint Louis County (MN) Surveyor: Polly Wong TINA SILVERNESS-ZINMER Initial Cert: 09/01/1998 Tina@cadt.org Phone: (18) 59-46 0/01/015 1/1/016 Fax: (18) 59-477 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 0/01/015 1/1/016 09/9/015 age 10 of 1

Sauk County SAUK COUNTY DEPARTMENT OF HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 71 505 BROADWAY BARABOO, WI 591 Sauk County Surveyor: Erin Taylor SHARON BOESL Initial Cert: 0/01/007 SBoesl@co.sauk.wi.us Phone: (608) 55-400 0/01/015 0/8/017 Fax: (608) 55-499 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 5959 0/01/015 0/8/017 SAUK COUNTY DEPARMENT OF HUMAN SERVICES Lic #: 184 505 BROADWAY STREET BARABOO, WI 591 Sauk County Surveyor: Hannah Whaley SHARON BOESL Initial Cert: 01/01/1988 sboesl@co.sauk.wi.us Phone: (608) 55-400 01/01/014 1/1/015 Fax: (608) 55-499 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 5959 01/01/014 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 Judy_Hannaford@ssmhc.com Phone: (608) 55-1759 0/01/014 01/1/016 Fax: (608) 56-165 CSAS-DAY TREATMENT DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 0/01/014 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 707-14TH STREET BARABOO, WI 591 Sauk County Surveyor: Hannah Whaley Lic #: 586 MARY SCHWARTZ Initial Cert: 07/01/004 mary_schwartz@ssmhc.com Phone: (608) 56-1400 04/01/014 0/1/016 Fax: (608) 56-167 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/014 0/1/016 09/9/015 age 10 of 1

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 tkirch@pathwayclinic.com Phone: (608) 64-66 01/01/014 1/1/015 Fax: (608) 64-5014 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 1104-1ST STREET SUITE E REEDSBURG, WI 5959 Sauk County Surveyor: Erin Taylor Lic #: 774 BARBARA GOODMAN Initial Cert: 0/06/008 goodmanbehavioralhealth@yahoo.c Phone: (608) 768-4545 0/01/015 0/8/017 Fax: (608) 768-4646 0/01/015 0/8/017 0/01/015 0/8/017 09/9/015 age 104 of 1

Sawyer County LAC COURTE ORIELLES COMMUNITY HEALTH CENTER Lic #: 1486 180 W TREPANIA ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong JENNY INGRAM Initial Cert: 0/01/1987 Jingram@lcohc.com Phone: (715) 68-5115 07/01/014 06/0/016 Fax: (715) 64-6107 CSAS-DAY TREATMENT DHS 75.1 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 NORTHWEST OASIS, 16096 US HWY 6, HAYWARD, WI 5484 07/01/014 06/0/016 LAC COURTE OREILLES OJIBWE SCHOOL, 8575 N. TREPANIA ROAD, HAYWARD, WI 5484 07/01/014 06/0/016 NOO JII MOO WII GA MIEG (LAC COURTE OREILLES HALFWAY HOUSE) Lic #: 470 199 W HASKINS ROAD HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong DOROTHY CRUST Initial Cert: 07/18/00 lcohwh@jrecoop.com Phone: (715) 64-5841 07/01/015 09/0/015 Fax: (715) 64-1059 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/015 09/0/015 SAWYER COUNTY HEALTH & HUMAN SERVICES/INFORMATION & REFERRAL CENTER Lic #: 185 10610 MAIN ST SUITE 4 HAYWARD, WI 5484 Sawyer County Surveyor: Polly Wong ALICIA CARLSON Initial Cert: 04/01/1979 acarlson@sawyerhs.hayward.wi.us Phone: (715) 64-4806 07/01/014 06/0/016 Fax: (715) 64-580 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 07/01/014 06/0/016 07/01/014 06/0/016 07/01/014 06/0/016 1 TRANSITION HOUSE, 1608 WOOD RIDGE LANE, HAYWARD, WI 5484 04/0/015 06/0/016 09/9/015 age 105 of 1

Shawano County STOCKBRIDGE-MUNSEE HEALTH AND WELLNESS CENTER Lic #: 188 W180 COUNTY HWY A BOWLER, WI 54416 Shawano County DELWAR MIAN Initial Cert: 06/19/014 Delwar.Mian@mohican.com Phone: (715) 79-000 08/01/015 07/1/016 Fax: (715) 79-11 08/01/015 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 sdakai@mitw.org Phone: (715) 799-85 1/01/01 11/0/015 Fax: (715) 799-86 CSAS-DAY TREATMENT DHS 75.1 CSAS-PREVENTION DHS 75.04 1/01/01 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 #: 181 504 LAKELAND ROAD SHAWANO, WI 54166 Shawano County JESSICA DELZER Initial Cert: 0/01/1977 jessica.delzer@co.shawano.wi.us Phone: (715) 54-6879 01/01/015 1/1/016 Fax: (715) 56-554 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 #: 86 504 LAKELAND ROAD SHAWANO, WI 54166 Shawano County JESSICA DELZER Initial Cert: 05/06/014 jessica.delzer@co.shawano.wi.us Phone: (715) 56-4700 07/01/015 06/0/017 Fax: (715) 56-554 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

SHAWANO MEDICAL CENTER 09 N. BARTLETT STREET SHAWANO, WI 54166 Shawano County Lic #: 18 PENNY BLOCK Initial Cert: 10/01/1978 penny.block@thedacare.org Phone: (715) 56-710 04/01/014 0/1/016 Fax: (715) 56-705 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 04/01/014 0/1/016 09/9/015 age 107 of 1

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 info@exodus-house.org Phone: (6) 66-4166 01/01/014 1/1/015 Fax: (6) 66-841 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 01/01/014 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 kay@hunholz.com Phone: (90) 89-7606 08/01/014 07/1/016 Fax: (90) 449-447 08/01/014 07/1/016 1 LIFE POINT COUNSELING, LLC, 601 N. 5TH STREET, SHEBOYGAN, WI 5081 06/11/015 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 tracy.lee-johnson@aurora.org Phone: (90) 459-1494 07/01/014 06/0/016 Fax: (90) 459-148 07/01/014 06/0/016 07/01/014 06/0/016 1 AURORA SHEBOYGAN CLINIC, 600 KILEY WAY, PLYMOUTH, WI 507 07/01/014 06/0/016 AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER Lic #: 185 69 N 7TH STREET SHEBOYGAN, WI 508 Sheboygan County LORI KNITT Initial Cert: 05/01/1987 lori.knitt@aurora.org Phone: (90) 451-5510 05/01/014 04/0/016 Fax: (90) 451-51 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 05/01/014 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

GENESIS SHEBOYGAN RESIDENTIAL PROGRAM Lic #: 179 50 E. WISCONSIN AVENUE SHEBOYGAN, WI 5081 Sheboygan County GINA SINGLETERY Initial Cert: 11/01/1991 gina.singletery@corizonhealth.com Phone: (90) 457-780 11/01/014 10/1/015 Fax: (90) 457-7947 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 11/01/014 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 office@nett-workfamilycounseling.or Phone: (90) 451-6908 0/01/014 0/9/016 Fax: (90) 458-649 0/01/014 0/9/016 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 1011-10TH STREET #1, MANITOWOC, WI 540 0/01/014 0/9/016 1 NETT-WORK FAMILY COUNSELING LLC, 140 MILWAUKEE DR, NEW HOLSTEIN, WI 5061 0/01/014 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 5081 0/01/014 0/9/016 NORTHSHORE CLINIC LLC 805 NORTH 6TH STREET SHEBOYGAN, WI 5081 Sheboygan County Lic #: 1699 LORI DIELENTHEIS Initial Cert: 08/01/1991 nsc@northshoreclinic.org Phone: (90) 457-8866 0/01/014 01/1/016 Fax: (90) 457-8867 0/01/014 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 charlieqam@yahoo.com Phone: (90) 458-657 01/01/015 1/1/016 Fax: (90) 458-66 CSAS-NARCOTIC TREATMENT DHS 75.15 01/01/015 1/1/016 01/01/015 1/1/016 09/9/015 age 109 of 1

SHEBOYGAN COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 184 1011 N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County JODY A GALLAWAY, PSYD Initial Cert: 07/01/1986 jody.gallaway@sheboygancounty.co Phone: (90) 459-155 10/01/014 09/0/016 Fax: (90) 459-45 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 #: 667 1011 N 8TH STREET SHEBOYGAN, WI 5081 Sheboygan County AMY CULVER Initial Cert: 05/01/006 culveajc@co.sheboygan.wi.us Phone: (90) 459-171 06/01/014 05/1/016 Fax: (90) 459-45 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 #: 1504 108 KOHLER MEMORIAL DRIVE SHEBOYGAN, WI 5081 Sheboygan County BARBARA CONIFF Initial Cert: 01/16/1988 barbara.coniff@hshs.org Phone: (90) 80-0740 04/01/015 0/1/017 Fax: (90) 498-8600 04/01/015 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 jeff.stumbras@prevea.com Phone: (90) 7-100 10/7/014 10/1/015 Fax: (90) 7-101 10/7/014 10/1/015 10/7/014 10/1/015 09/9/015 age 110 of 1

Taylor County COUNSELING CONNECTION OF MEDFORD 1 WEST STATE STREET, #4 MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong Lic #: 75 KELLY SCHULTZ Initial Cert: 09/01/007 counselingconnection@tds.net Phone: (715) 748-41 09/01/014 08/1/016 Fax: (715) 748-4407 09/01/014 08/1/016 09/01/014 08/1/016 1 CADOTT MEDICAL CENTER-COUNSELING CONNECTION, NORTH MAIN ST, CADOTT, WI 5477 09/01/014 08/1/016 1 PHOENIX HOUSE, 600 W. HICKORY STREET, GILMAN, WI 544 08/1/016 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 54451 09/01/014 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 54451 Taylor County Surveyor: Polly Wong Lic #: 05 KAREN MUNDT Initial Cert: 09/04/014 Karen.Mundt@hotmail.com Phone: (715) 05-811 09/01/015 08/1/017 Fax: 09/01/015 08/1/017 TAYLOR COUNTY HUMAN SERVICES DEPARTMENT Lic #: 1898 540 E. COLLEGE STREET MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 06/01/198 jen.meyer@co.taylor.wi.us Phone: (715) 748-07/01/014 06/0/016 Fax: (715) 748-4 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 #: 080 540 E COLLEGE ST MEDFORD, WI 54451 Taylor County Surveyor: Polly Wong JEN MEYER Initial Cert: 07/01/015 jen.meyer@co.taylor.wi.us Phone: (715) 748-07/01/015 06/0/016 Fax: (715) 748-4 CCS REGIONAL MODEL SHARED SERVICES DHS 6 07/01/015 06/0/016 09/9/015 Page 111 of 1

Trempealeau County WEST CENTRAL WISCONSIN BEHAVIORAL HEALTH CLINIC Lic #: 54 06 WHITEHALL RD INDEPENDENCE, WI 54747 Trempealeau County Surveyor: Roderic Senn TODD PYKA Initial Cert: 09/0/004 tpyka@tchcc.com Phone: (715) 84-81 09/01/015 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 #: 094 645 MAIN ST WHITEHALL, WI 5477 Trempealeau County Surveyor: Roderic Senn DEBRA SUCHLA Initial Cert: 09/01/015 debras@tremplocounty.com Phone: (715) 58-11 09/01/015 08/1/016 Fax: (715) 58-4174 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

Vernon County CENTER POINT COUNSELING SERVICES COOPERATIVE Lic #: 955 10 AIRPORT RD SUITE 10 VIROQUA, WI 54665 Vernon County SHERI HAMMOND shammond@centerpoint.coop Phone: (608) 68-740 Fax: (608) 68-749 Initial Cert: 1/01/011 1 1 1 BETHEL HOME & SERVICES, 614 SOUTH ROCK AVENUE, VIROQUA, WI 54665 BETHEL HOME & SERVICES, 60 SOUTH GARFIELD, VIROQUA, WI 54665 CENTER POINT CNSLNG SVS VERNON MANOR, E7404A COUNTY ROAD BB, VIROQUA, WI 54665 COON VALLEY ELEMENTARY SCHOOL, 00 LIEN STREET, COON VALLEY, WI 546 VIROQUA MIDDLE & HIGH SCHOOL, 100 BLACKHAWK DRIVE, VIROQUA, WI 54665 VIROQUA ELEMENTARY SCHOOL, 115 NORTH EDUCATION AVE, VIROQUA, WI 54665 WESTBY ELEMENTARY SCHOOL, 1 NELSON STREET, WESTBY, WI 54667 WESTBY MIDDLE & HIGH SCHOOL, 06 WEST AVENUE SOUTH, WESTBY, WI 54667 STRIVE COMPREHENSIVE COMMUNITY SERVICES Lic #: 09 18 FAIRLANE DRIVE SUITE 100 VIROQUA, WI 54665 Vernon County Surveyor: Roderic Senn REBECCA MILLER Initial Cert: 08/01/015 striveccs@centerpoint.coop Phone: (608) 67-510 08/01/015 07/1/016 Fax: (608) 67-5505 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 54665 Vernon County Surveyor: Roderic Senn Lic #: 196 SUE SULLIVAN Initial Cert: 0/01/1978 ssullivan@vmh.org Phone: (608) 67-101 09/01/014 08/1/016 Fax: (608) 67-141 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 09/01/014 08/1/016 09/9/015 age 11 of 1

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 dwildcat@ldftribe.com Phone: (715) 588-1511 09/01/015 10/1/015 Fax: (715) 588-90 09/01/015 10/1/015 09/01/015 10/1/015 1 DOMESTIC ABUSE PROGRAM, 157 CEDAR AVENUE, LAC DU FLAMBEAU, WI 5458 07/06/016 10/1/015 1 SOBER HOME - MEN'S, 119 ARNOLD STOCK ROAD, LAC DU FLAMBEAU, WI 5458 07/06/016 10/1/015 1 SOBER HOME - WOMEN'S, 55 BOBIDOSH POINT LANE, LAC DU FLAMBEAU, WI 5458 07/06/016 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 54548 09/01/015 10/1/015 09/01/015 10/1/015 LAC DU FLAMBEAU HEALTH & HUMAN SERVICES CCS Lic #: 071 19 OLD ABE ROAD LAC DU FLAMBEAU, WI 5458 Vilas County Surveyor: Polly Wong RYAN CHAMPAGNE Initial Cert: 0/01/015 RChampagne@ldftribe.com Phone: (715) 588-71 0/01/015 01/1/016 Fax: (715) 588-09 CCS REGIONAL MODEL POPULATION-BASED DHS 6 0/01/015 01/1/016 09/9/015 age 114 of 1

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 ksteen@credencetherapy.org Phone: (6) 7-44 1/01/014 11/0/016 Fax: (6) 7-808 1/01/014 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 511 09/14/016 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 gina.singletery@corizonhealth.com Phone: (6) 7-59 09/01/015 08/1/016 Fax: (6) 7-69 09/01/015 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 lkadlec@co.walworth.wi.us Phone: (6) 741-00 0/01/015 01/1/017 Fax: (6) 741-17 CCS REGIONAL MODEL SHARED SERVICES DHS 6 0/01/015 01/1/017 09/9/015 age 115 of 1

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 nevicosi@co.walworth.wi.us Phone: (6) 741-00 09/01/014 08/1/016 Fax: (6) 741-17 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. 4851 HWY 6 SOUTH SPOONER, WI 54801 Washburn County Surveyor: Polly Wong Lic #: 61 ANDREW WOLF Initial Cert: 01/01/006 awolf@auroraservices.com Phone: (715) 65-4858 01/01/014 1/1/015 Fax: (715) 65-4861 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 5470 08/01/014 1/1/015 1 ACCESS, INC, 100 POLK COUNTY PLAZA, #70, BALSAM LAKE, WI 54810 08/01/014 1/1/015 1 ACCESS, INC, 0 E LASALLE STREET, BARRON, WI 5481 01/01/014 1/1/015 1 ACCESS, INC. DBA AURORA COMMUNITY COUNSELING, 915 INDIANHEAD DR., MOSINEE, WI 54455 08/01/014 10/01/014 ACCESS, INC - LADYSMITH, 108 W. ND STREET N, LADYSMITH, WI 54848 ACCESS, INC - LADYSMITH, 804 W 9TH STREET N, SUITE B, LADYSMITH, WI 54848 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 54801 ACCESS INC-LADYSMITH ELEMENTARY SCHOOL, 64 EAST 6TH STREET, LADYSMITH, WI 54848 ACCESS, INC - SPOONER MIDDLE SCHOOL, 750 OAK STREET, SPOONER, WI 54801 ACCESS, INC-LADYSMITH MIDDLE SCHOOL, 115 E 6TH STREET SOUTH, LADYSMITH, WI 54848 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 54840 08/0/015 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

Washington County GENESIS BEHAVIORAL SERVICES HARTFORD OUTPATIENT CLINIC Lic #: 176 1567 E. SUMNER STREET HARTFORD, WI 507 Washington County GINA SINGLETERY Initial Cert: 04/01/1994 gina.singletery@corizonhealth.com Phone: (6) 67-4477 04/01/014 0/1/016 Fax: (6) 67-4477 04/01/014 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 msimon@elevateyou.org Phone: (6) 677-16 0/01/015 0/8/017 Fax: (6) 677-14 CSAS-INTERVENTION DHS 75.16 CSAS-PREVENTION DHS 75.04 0/01/015 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 acs001@affiliatedclinical.com Phone: (6) 8-717 06/01/015 06/0/016 Fax: (6) 8-9767 06/01/015 06/0/016 06/01/015 06/0/016 AFFILIATED CLINICAL SERVICES INC, 8 SELL DRIVE #B, HARTFORD, WI 507 06/01/015 06/0/016 WEST BEND EAST & WEST HIGH SCHOOL, 105 E. DECORAH RD., RM N 15, WEST BEND, WI 5095 06/01/015 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 acs001@affiliatedclinical.com Phone: (6) 8-717 06/01/015 0/9/016 Fax: (6) 8-9767 CSAS-DAY TREATMENT DHS 75.1 06/01/015 0/9/016 09/9/015 age 117 of 1

CALM HARBOR 141 SOUTH 8TH AVE WEST BEND, WI 5095 Washington County Lic #: 641 MARY SIMON Initial Cert: 0/01/006 kfies@elevateyou.org Phone: (6) 8-6070 0/01/015 0/8/017 Fax: (6) 677-14 CSAS-RESIDENTIAL INTOXICATION MONITORING DHS 75.09 0/01/015 0/8/017 GENESIS BEHAVIORAL SERVICES, INC. WEST BEND OUTPATIENT CLINIC Lic #: 1465 166 CLARENCE COURT WEST BEND, WI 5095 Washington County GINA SINGLETERY Initial Cert: 01/01/1987 Gina.singletery@corizonhealth.com Phone: (414) 777-1570 01/01/014 1/1/015 Fax: (414) 777-1565 CSAS-DAY TREATMENT DHS 75.1 01/01/014 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 Eric.Diamond@co.washington.wi.us Phone: (6) 5-4599 0/01/014 0/9/016 Fax: (6) 5-687 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

Waukesha County CORNERSTONE COUNSELING SERVICES, INC. 1655 W. BLUEMOUND ROAD, #00 BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner Lic #: 17 SANDRA ADAMS Initial Cert: 0/01/199 ccshelp@ccs.com Phone: (6) 789-1191 0/01/014 0/9/016 Fax: (6) 81-6180 0/01/014 0/9/016 0/01/014 0/9/016 1 CORNERSTONE COUNSELING SERVICES, INC., 10 S MAIN STREET, #10, JEFFERSON, WI 5549 0/01/014 0/9/016 CORNERSTONE COUNSELING SERVICES, INC, 5007 S HOWELL AVENUE, SUITE 50, MILWAUKEE, WI CORNERSTONE COUNSELING SERVICES, INC., 10850 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 #: 654 1950 W CAPITOL DR ND FLOOR BROOKFIELD, WI 5005 Waukesha County Surveyor: William Rohner CAROL HESS Initial Cert: 07//005 Carol.Hess@wfhc.org Phone: (414) 874-688 09/01/015 08/1/017 Fax: (414) 874-691 09/01/015 08/1/017 09/01/015 08/1/017 1 WHEATON FRANCISCAN BEHAVIORAL HEALTH, 19 CAPITOL DRIVE, PEWAUKEE, WI 507 09/01/015 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 bcwbinder@yahoo.com Phone: (6) 896-0905 08/8/015 01/1/017 Fax: (6) 781-67 08/8/015 01/1/017 1 ALLIANCE COUNSELING CENTER, 1 N GRANDVIEW BOULEVARD, #10, WAUKESHA, WI 5188 08/8/015 01/1/017 1 ALLIANCE COUNSELING CENTER, N91 W17194 APPLETON AVE, #105, MENOMONEE FALLS, WI 5051 08/8/015 01/1/017 09/9/015 age 119 of 1

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 ldunn@froedterthealth.org Phone: (6) 57-580 09/01/014 08/1/016 Fax: (6) 57-570 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 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 klotz@rogershospital.org Phone: (6) 646-4411 11/01/01 10/1/015 Fax: (6) 646-158 CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-OUTPATIENT TREATMENT WITH TELEHEALTH DHS 75.1 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-DAY TREAT/CHLDREN W/TELEHEALTH DHS 40.11() MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-DAY TREATMENT FOR CHILDREN DHS 40.11() MENTAL HEALTH-DAY TREATMENT WITH TELEHEALTH DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 11/01/01 10/1/015 ROGERS MEMORIAL HOSPITAL - HERRINGTON RECOVERY CENTER Lic #: 070 4700 VALLEY ROAD OCONOMOWOC, WI 5066 Waukesha County Surveyor: William Rohner CINDY SUSZEK Initial Cert: 06/01/1998 csuszek@rogershospital.org Phone: (6) 646-1616 06/01/015 05/1/017 Fax: (6) 646-158 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 06/01/015 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 dgarrison@earthlink.net Phone: (6) 691-980 09/01/014 08/1/016 Fax: (6) 691-4966 09/01/014 08/1/016 09/9/015 age 10 of 1

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 MLindblade@rosecrance.org Phone: (815) 87-494 0/01/014 01/1/016 Fax: (815) 544-116 0/01/014 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 carrie.kelsey@quadmedical.com Phone: (414) 566-6080 1/01/01 11/0/015 Fax: (414) 566-808 1/01/01 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 5048 1/01/01 11/0/015 1 QUAD/GRAPHICS, N6 W075 HWY 74, SUSSEX, WI 5089 1/01/01 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 aschabel@correctionalservices.org Phone: (6) 51-9616 08/9/015 0/9/016 Fax: (6) 51-9617 1 ACS CLINICAL SERVICES, LLC - BEAVER DAM, 0 SEIPPEL BLVD., BEAVER DAM, WI 5916 08/9/015 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 571 08/9/015 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 jmuchka@arcouncil.net Phone: (6) 54-791 07/01/015 06/0/017 Fax: (6) 54-79 CSAS-INTERVENTION DHS 75.16 CSAS-PREVENTION DHS 75.04 07/01/015 06/0/017 07/01/015 06/0/017 09/9/015 age 11 of 1

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 kate.connelly@aurora.org Phone: (414) 454-6506 05/01/014 04/0/016 Fax: (414) 454-6450 05/01/014 04/0/016 05/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER - BROOKFIELD, 16985 WEST BLUEMOUND ROAD, BROOKFIE 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-NEW BERLIN, 14555 W NATIONAL AVE, NEW BERLIN, WI 51 10/01/014 04/0/016 AURORA BEHAVIORAL HEALTH CENTER-WAUKESHA, 6500 AURORA DRIVE, SUMMIT, WI 5066 05/01/014 04/0/016 GENESIS HOUSE - LUTHERAN SOCIAL SERVICES Lic #: 18 100 MOTOR AVENUE WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner JAMES AKER Initial Cert: 07/01/1994 james.aker@lsswis.org Phone: (6) 544-0711 07/01/014 06/0/016 Fax: (6) 544-11 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 07/01/014 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 emily@hhcppo.com Phone: (414) 06-6550 08/01/014 07/1/016 Fax: (414) 06-6550 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

PROHEALTH CARE MEDICAL ASSOCIATES, INC. BEHAVIORAL HEALTH SERVICES Lic #: 1974 71 AMERICAN AVENUE #501 WAUKESHA, WI 5188 Waukesha County Surveyor: William Rohner O. KIRK YAUCHLER Initial Cert: 06/01/1986 Olin.yauchler@phci.org Phone: (6) 98-406 10/01/015 1/1/015 Fax: (6) 98-5096 10/01/015 1/1/015 10/01/015 1/1/015 1 PROHEALTH CARE SLEEP CENTER, 01 SUN VALLEY DRIVE #00, DELAFIELD, WI 5018 10/01/015 1/1/015 1 WAUKESHA HEALTH SYS DBA BMC, 10 BIG BEND ROAD, WAUKESHA, WI 5189 10/01/015 1/1/015 WAUKESHA HEALTH SYS DBA BMC @ PHCMA - WATERTOWN, 109 AIR PARK DR., WATERTOWN, WI 5 WAUKESHA HEALTH SYS DBA BMC @ PHCMA PEWAUKEE, N16W411 RIVERWOOD DR., WAUKESHA WAUKESHA HEALTH SYS DBA BMC @ 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 wkohlhaas@qam-inc.com Phone: (6) 549-6600 09/01/015 08/1/017 Fax: (6) 549-6698 CSAS-NARCOTIC TREATMENT DHS 75.15 09/01/015 08/1/017 09/01/015 08/1/017 SIXTEENTH STREET COMMUNITY HEALTH CENTERS DBA WAUKESHA COMMUNITY HEALTH CENTER Lic #: 04 09 EAST NORTH STREET WAUKESHA, WI 5186 Waukesha County MARIA ELENA PEREZ, PHD Initial Cert: 04/01/014 maria.perez@sschc.org Phone: (6) 408-50 04/01/015 0/1/017 Fax: (414) 408-5087 04/01/015 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 dbirdeau@waukeshacounty.gov Phone: (6) 548-7978 07/01/014 06/0/016 Fax: (6) 896-8180 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 5188 07/01/014 06/0/016 09/9/015 age 1 of 1

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 gowley@waukeshacounty.gov Phone: (6) 548-7666 05/01/015 04/0/017 Fax: (6) 548-7656 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 5188 05/01/015 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 jlewis@waukeshacounty.gov Phone: (6) 548-7950 05/01/014 04/0/016 Fax: (6) 896-8046 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 05/01/014 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 corrine.gresen@phci.org Phone: (6) 98-84 01/01/015 1/1/016 Fax: (6) 98-816 CSAS-DAY TREATMENT DHS 75.1 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 MENTAL HEALTH-DAY TREATMENT DHS 61.75 MENTAL HEALTH-INPATIENT DHS 61.71 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 09/9/015 age 14 of 1

Waupaca County MINISTRY BEHAVIORAL HEALTH 190 GRAND SEASONS DRIVE WAUPACA, WI 54981 Waupaca County Surveyor: Hannah Whaley Lic #: 645 TERESA TAYLOR Initial Cert: 0/01/006 terri.taylor@ministryhealth.org Phone: (715) 58-8459 0/01/014 01/1/016 Fax: (715) 58-0878 0/01/014 01/1/016 0/01/014 01/1/016 WAUPACA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Lic #: 1977 811 HARDING STREET WAUPACA, WI 54981 Waupaca County Surveyor: Hannah Whaley CHUCK PRICE Initial Cert: 1/01/1981 wcdhhs@co.waupaca.wi.us Phone: (715) 58-604 07/01/014 06/0/016 Fax: (715) 58-6409 CSAS-EMERGENCY OUTPATIENT DHS 75.05 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 54961 07/01/014 06/0/016 09/9/015 age 15 of 1

Waushara County ALL AREA COUNSELING SERVICES-A DIVISION OF OPTIONS TREATMENT PROGRAMS INC Lic #: 51 719 W MAIN STREET WAUTOMA, WI 5498 Waushara County Surveyor: Hannah Whaley KIMEKO HAGEN Initial Cert: 04/01/004 khagen@optionstx.com Phone: (90) 787-747 04/01/014 0/1/016 Fax: (90) 787-5458 04/01/014 0/1/016 04/01/014 0/1/016 1 INTEGRATIVE PAIN MANAGEMENT SC, 555 S WASHBURN ST #A, OSHKOSH, WI 54904 04/01/014 08/5/014 OPTIONS TREATMENT PROGRAMS, INC., 1000 N. LYNNDALE DRIVE STE C, APPLETON, WI 54914 OPTIONS TREATMENT PROGRAMS, INC., 44 S MONROE AVE #01, GREEN BAY, WI 5401 OPTIONS TREATMENT PROGRAMS, INC., 9 CHURCHILL ST, WAUPACA, WI 54981 OPTIONS TREATMENT PROGRAMS-OSHKOSH, 50 E. NEW YORK AVE., OSHKOSH, WI 54901 04/01/014 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 #: 1980 0 W. PARK STREET WAUTOMA, WI 5498 Waushara County Surveyor: Erin Taylor TONI MORGAN JONES Initial Cert: 10/01/1975 tonimj.parkstreet@co.waushara.wi.u Phone: (90) 787-6550 11/01/014 10/1/016 Fax: (90) 787-041 CSAS-PREVENTION DHS 75.04 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 549 11/01/014 10/1/016 TRI-COUNTY HIGH SCHOOL, 409 S WEST STREET, PLAINFIELD, WI 54966 11/01/014 10/1/016 WAUTOMA HIGH SCHOOL, 514 S CAMBRIDGE STREET, WAUTOMA, WI 5498 11/01/014 10/1/016 WESTFIELD AREA MIDDLE/HIGH SCHOOL, N 7046 COUNTY ROAD CH, WESTFIELD, WI 5964 11/01/014 10/1/016 WILD ROSE SCHOOL DISTRICT, 600 PARK AVE, WILD ROSE, WI 54984 11/01/014 10/1/016 WAUSHARA COUNTY HUMAN SERVICES COMPREHENSIVE COMMUNITY SERVICES Lic #: 618 0 W PARK STREET WAUTOMA, WI 5498 Waushara County Surveyor: Erin Taylor RENEE SOROKO Initial Cert: 10/19/005 renees.parkstreet@co.waushara.wi. Phone: (90) 787-6550 11/01/014 10/1/016 Fax: (90) 787-041 CCS REGIONAL MODEL SHARED SERVICES DHS 6 11/01/014 10/1/016 09/9/015 age 16 of 1

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 HRACLLC1@yahoo.com Phone: (90) 7-011 04/01/015 0/1/017 Fax: (90) 7-01 04/01/015 0/1/017 THE SAMARITAN COUNSELING CENTER OF THE FOX VALLEY Lic #: 155 1478 KENWOOD DRIVE SUITE 1 MENASHA, WI 5495 Winnebago County ROSANGELA BERBERT Initial Cert: 0/01/198 rberbert@samaritan-counseling.com Phone: (90) 886-919 0/01/015 0/8/017 Fax: (90) 886-957 0/01/015 0/8/017 0/01/015 0/8/017 1 PROJECT OPEN DOOR IMMANUEL UNITED CHURCH, 510 SULLIVAN AVENUE, KAUKAUNA, WI 5410 0/01/015 0/8/017 1 THE SAMARITAN COUNSELING CENTER OF FV AT LHCC, 510 DOCTORS COURT, OSHKOSH, WI 54901 0/19/016 0/8/017 1 THE SAMARITAN COUNSELING CTR FOX VALLEY, 1478 MIDWAY ROAD, MENASHA, WI 5495 0/01/015 0/8/017 THE SAMARITAN COUNSELING CTR FOX VALLEY, 110 CHURCH AVENUE, OSHKOSH, WI 54901 THE SAMARITAN COUNSELING CTR FOX VALLEY, 709 W PINE STREET, NEW LONDON, WI 54961 0/01/015 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 jean.dekeyser@thedacare.org Phone: (90) 70-00 07/01/014 06/0/016 Fax: (90) 70-719 CSAS-DAY TREATMENT DHS 75.1 MENTAL HEALTH OUTPATIENT CLINIC WITH TELEHEALTH DHS 5 MENTAL HEALTH-DAY TREATMENT DHS 61.75 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 THEDACARE BEHAVIORAL HEALTH, 1405 MILL STREET, NEW LONDON, WI 54961 07/01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH, 100 COUNTY ROAD B, SHAWANO, WI 54166 THEDACARE BEHAVIORAL HEALTH, 1818 NORTH MEADE STREET, APPLETON, WI 54911 THEDACARE BEHAVIORAL HEALTH, 500 E CAPITAL DRIVE, APPLETON, WI 54911 THEDACARE BEHAVIORAL HEALTH, 600 N WESTHAVEN DRIVE, OSHKOSH, WI 54901 THEDACARE BEHAVIORAL HEALTH, 90 RIVERSIDE DRIVE, #04, WAUPACA, WI 54981 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 09/9/015 age 17 of 1

ESPRIT COUNSELING AND CONSULTING 40 JEWELERS PARK DRIVE NEENAH, WI 54956 Winnebago County Lic #: 968 KERRIE JO LARSON Initial Cert: 07/6/01 Kerrie@espritcounseling.com Phone: (90) 70-6000 07/01/014 06/0/016 Fax: (90) 4-041 07/01/014 06/0/016 THEDACARE BEHAVIORAL HEALTH AT THEDA CLARK MEDICAL CENTER Lic #: 1946 10 SECOND STREET NEENAH, WI 54956 Winnebago County COLLETTE HARTFIEL Initial Cert: 0/01/198 collette.hartfiel@thedacare.org Phone: (90) 79-0 0/01/015 01/1/017 Fax: (90) 79-906 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 01/1/017 0/01/015 01/1/017 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 006 11 N COMMERCIAL STREET NEENAH, WI 54956 Winnebago County MICHAEL DAEHN PHD Initial Cert: 07/01/1988 mdaehn@co.winnebago.wi.us Phone: (90) 79-777 11/01/014 10/1/016 Fax: (90) 70-968 11/01/014 10/1/016 11/01/014 10/1/016 AMS OF WISCONSIN, LLC - OSHKOSH 505 S WASHBURN STREET OSHKOSH, WI 54904 Winnebago County Surveyor: Erin Taylor Lic #: 089 SHAREL ROGERS Initial Cert: 09/04/015 sharelrae@aol.com Phone: (90) - 09/04/015 08/1/016 Fax: (90) -4 CSAS-NARCOTIC TREATMENT DHS 75.15 09/04/015 08/1/016 09/04/015 08/1/016 GENESIS BEHAVIORAL SVCS OSHKOSH RESIDENTIAL PROGRAM Lic #: 004 04 OTTER AVENUE OSHKOSH, WI 54901 Winnebago County GINA SINGLETERY Initial Cert: 09//01 gina.singletery@corizonhealth.com Phone: (90) 5-0 09/01/015 08/1/016 Fax: (90) 5-06 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 09/01/015 08/1/016 09/9/015 age 18 of 1

MERCY COUNSELING SERVICES 500 SOUTH OAKWOOD RD OSHKOSH, WI 54904 Winnebago County Lic #: 161 TINA LECHNIR Initial Cert: 0/01/1995 tlechnir@affinityhealth.org Phone: (90) 6-8570 09/01/014 08/1/016 Fax: (90) 6-8591 09/01/014 08/1/016 09/01/014 08/1/016 MERCY MEDICAL CENTER 500 S OAKWOOD ROAD OSHKOSH, WI 54904 Winnebago County Lic #: 1608 TINA LECHNIR Initial Cert: 0/01/198 tlechnir@affinityhealth.org Phone: (90) -400 09/01/014 08/1/016 Fax: (90) -404 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 MENTAL HEALTH-INPATIENT DHS 61.71 09/01/014 08/1/016 09/01/014 08/1/016 NOVA COUNSELING SERVICES, INC 40 JACKSON STREET OSHKOSH, WI 54901 Winnebago County Lic #: 1710 HUGH HOLLY Initial Cert: 11/01/1985 hugh@novaoshkosh.com Phone: (90) 1-014 05/01/014 04/0/016 Fax: (90) 1-446 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 CSAS-TRANSITIONAL RESIDENTIAL DHS 75.14 05/01/014 04/0/016 05/01/014 04/0/016 05/01/014 04/0/016 WINNEBAGO COUNTY DEPARTMENT OF HUMAN SERVICES Lic #: 007 0 WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN Initial Cert: 10/01/1975 mdaehn@co.winnebago.wi.us Phone: (90) 6-4700 11/01/014 10/1/016 Fax: (90) 6-1157 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-PREVENTION DHS 75.04 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

WINNEBAGO COUNTY DHS COMPREHENSIVE COMMUNITY SERVICES Lic #: 579 0 WASHINGTON AVENUE OSHKOSH, WI 5490 Winnebago County MICHAEL DAEHN PHD Initial Cert: 0/09/005 Mdaehn@co.winnebago.wi.us Phone: (90) 6-4700 04/01/015 0/1/017 Fax: (90) 0-479 CCS REGIONAL MODEL SHARED SERVICES DHS 6 04/01/015 0/1/017 WINNEBAGO MENTAL HEALTH INSTITUTE TREFFERT DRIVE & BUTLER AVENUE WINNEBAGO, WI 54985 Winnebago County Lic #: 008 THOMAS SPEECH Initial Cert: 10/01/1975 Phone: (90) 5-4910 11/01/01 10/1/015 Fax: (90) 7-04 CSAS-MEDICALLY MANAGED INPATIENT TREATMENT DHS 75.10 CSAS-MEDICALLY MONITORED TREATMENT DHS 75.11 MENTAL HEALTH-ADOLESCENT INPATIENT DHS 61.79 MENTAL HEALTH-INPATIENT DHS 61.71 11/01/01 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 55987 Winona County (MN) Surveyor: Roderic Senn Lic #: 8 JULIE HANSON Initial Cert: 09/1/009 julieh@hvmhc.org Phone: (507) 454-441 09/01/014 08/1/016 Fax: (507) 45-667 09/01/014 08/1/016 09/01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 19 MAIN STREET, LA CROSSE, WI 54601 09/01/014 08/1/016 1 HIAWATHA VALLEY MENTAL HEALTH CENTER, 611 BROADWAY AVENUE, #100, WABASHA, MN 55981 09/01/014 08/1/016 HIAWATHA VALLEY MENTAL HEALTH CENTER, 85 S. SERVICE DR., STE. 10, RED WING, MN 55066 HIAWATHA VALLEY MENTAL HEALTH CENTER, LA CROSSE CNTY JUVE FAC.- 00 4TH ST NORTH, LA C 06/05/015 08/1/016 09/01/014 08/1/016 09/9/015 age 10 of 1

Wood County HERGERT & ASSOCIATES FAMILY COUNSELING SERVICES Lic #: 669 5 S CENTRAL AVENUE, #1 MARSHFIELD, WI 54449 Wood County Surveyor: Hannah Whaley LISA HERGERT Initial Cert: 05/08/006 lrherge@aol.com Phone: (715) 84-7579 01/01/015 1/1/015 Fax: (715) 84-811 01/01/015 1/1/015 NORWOOD HEALTH CENTER 1600 N. CHESTNUT AVENUE MARSHFIELD, WI 54449 Wood County Surveyor: Erin Taylor Lic #: 1709 RHONDA KOZIK Initial Cert: 04/01/1980 rkozik@co.wood.wi.us Phone: (715) 84-188 0/01/015 01/1/017 Fax: (715) 89-66 CSAS-MEDICALLY MONITORED RESIDENTIAL DETOX DHS 75.07 MENTAL HEALTH-INPATIENT DHS 61.71 0/01/015 01/1/017 0/01/015 01/1/017 OLSON PROFESSIONAL COUNSELING SERVICES LLC Lic #: 078 5 S CENTRAL AVE STE 4 MARSHFIELD, WI 54449 Wood County Surveyor: Hannah Whaley JERRY OLSON Initial Cert: 01/05/015 jerrycounseling@hotmail.com Phone: (715) 84-7884 01/05/015 1/1/015 Fax: (715) 84-7881 01/05/015 1/1/015 CHILD & ADOLESCENT PSYCHIATRY CONSULTING LLC Lic #: 981 90 8TH ST SOUTH STE #101 WISCONSIN RAPIDS, WI 54494 Wood County Surveyor: Erin Taylor DEB FUEHRER Initial Cert: 09/7/01 office@drjenna.net Phone: (715) 4-00 09/01/015 08/1/016 Fax: (888) 485-441 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 54449 09/01/015 08/1/016 09/9/015 age 11 of 1

CLINICAL SERVICES 40-1ST AVENUE SOUTH WISCONSIN RAPIDS, WI 54495 Wood County Surveyor: Erin Taylor Lic #: 108 DR MICHAEL J NELSON Initial Cert: 10/01/1988 clinicalservices@solarus.net Phone: (715) 44-400 10/01/015 09/0/017 Fax: (715) 44-441 CSAS-INTERVENTION DHS 75.16 10/01/015 09/0/017 10/01/015 09/0/016 RIVERVIEW HOSPITAL ASSOCIATION 410 DEWEY STREET WISCONSIN RAPIDS, WI 54495 Wood County Surveyor: Hannah Whaley Lic #: 180 COLLEEN KANE Initial Cert: 07/01/1986 kancol@rhahealthcare.org Phone: (715) 4-6060 07/01/014 06/0/016 Fax: (715) 41-7576 CSAS-MEDICALLY MANAGED INPATIENT DETOX DHS 75.06 07/01/014 06/0/016 WOOD COUNTY HUMAN SERVICES CCS 611-1TH AVENUE, SOUTH WISCONSIN RAPIDS, WI 54494 Wood County Surveyor: Hannah Whaley Lic #: 678 KATHY ROETTER Initial Cert: 08/01/1977 kroetter@co.wood.wi.us Phone: (715) 41-8800 07/01/014 06/0/016 Fax: (715) 41-66 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 #: 019 611-1TH STREET SOUTH WISCONSIN RAPIDS, WI 54494 Wood County Surveyor: Hannah Whaley SUSAN SCHUELER-SHEVELAND Initial Cert: 08/01/1977 Phone: (715) 41-8849 07/01/014 06/0/016 Fax: (715) 41-66 CSAS-DAY TREATMENT DHS 75.1 CSAS-DAY TREATMENT WITH TELEHEALTH DHS 75.1 CSAS-EMERGENCY OUTPATIENT DHS 75.05 CSAS-EMERGENCY OUTPATIENT WITH TELEHEALTH DHS 75.05 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 54449 07/01/014 06/0/016 09/9/015 age 1 of 1