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1508806001
JERRY W SAMPLE
LA CROSSE, WI
NPI
1508806001
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI 11750)
Enumeration Date
2006-06-07
Last Update Date
2007-07-08
Business Address
-- JERRY W SAMPLE CADC
1910 SOUTH AVE
LA CROSSE, WI 54601-5467
Phone number: 608-782-7300
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Mailing Address
-- JERRY W SAMPLE CADC
1910 SOUTH AVE
LA CROSSE, WI 54601-5467
Phone number: 608-782-7300
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