JACOB J LICHMAN

MONTELLO, WI
NPI1306140967
Other NameJAY J LICHMAN
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  1853-132)
Enumeration Date2010-12-22
Last Update Date2010-12-22
Business Address
-- JACOB J LICHMAN CSAC IDP/AT
N3829 STATE ROAD 22
MONTELLO, WI 53949-9049
Phone number: 608-297-2085
Mailing Address
-- JACOB J LICHMAN CSAC IDP/AT
PO BOX 57
MONTELLO, WI 53949-0057
Phone number: 608-297-2085