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1316141278
JACOB M LIBSTER
KENOSHA, WI
NPI
1316141278
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2007-06-13
Last Update Date
2007-07-08
Business Address
-- JACOB M LIBSTER BSW
5407 8TH AVE
KENOSHA, WI 53140-3715
Phone number: 262-564-0067
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Mailing Address
-- JACOB M LIBSTER BSW
848 STATE ROAD 60
CEDARBURG, WI 53012-9216
Phone number: 262-375-6794
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