JERRY W SAMPLE

LA CROSSE, WI
NPI1508806001
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  11750)
Enumeration Date2006-06-07
Last Update Date2007-07-08
Business Address
-- JERRY W SAMPLE CADC
1910 SOUTH AVE
LA CROSSE, WI 54601-5467
Phone number: 608-782-7300
Mailing Address
-- JERRY W SAMPLE CADC
1910 SOUTH AVE
LA CROSSE, WI 54601-5467
Phone number: 608-782-7300
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