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Addiction Substance Use Disorder

Onalaska, Wisconsin

Provider NPI: 1427059088

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
123 16TH AVE S  ONALASKA, WI 54650 US
Tel: 608-775-8646  Fax: --

Business Mailing Address:
Tel: 608-782-7300  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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