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1376021782
JASEN ALAN EBERHARDT
WAUKESHA, WI
NPI
1376021782
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI 18552-130)
Enumeration Date
2018-07-30
Last Update Date
2018-07-30
Business Address
Mr. JASEN ALAN EBERHARDT SAC-IT
223 WISCONSIN AVE STE B
WAUKESHA, WI 53186-4968
Phone number: 262-701-7257
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Mailing Address
Mr. JASEN ALAN EBERHARDT SAC-IT
223 WISCONSIN AVE STE B
WAUKESHA, WI 53186-4968
Phone number: 262-701-7257
Copy
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