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1114225216
KELLY J JODAR
SHEBOYGAN, WI
NPI
1114225216
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WI 15433132)
Enumeration Date
2011-03-14
Last Update Date
2011-03-14
Business Address
KELLY J JODAR CSAC
2842 S BUSINESS DR
SHEBOYGAN, WI 53081-6518
Phone number: 262-549-6600
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Mailing Address
KELLY J JODAR CSAC
2422 N GRANDVIEW BLVD
WAUKESHA, WI 53188-6105
Phone number: 262-549-6600
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