| NPI | 1528507605 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TED IZYDOR Owner 608-205-2294 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 14034) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 2878) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2017-02-22 |