WALLACE EDWARD BRANDIES

RACINE, WI
NPI1811595671
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  15295-132)
Enumeration Date2020-10-14
Last Update Date2020-10-14
Business Address
Mr. WALLACE EDWARD BRANDIES CSAC ICS
1717 TAYLOR AVE
RACINE, WI 53403-2405
Phone number: 262-638-6635
Mailing Address
Mr. WALLACE EDWARD BRANDIES CSAC ICS
1717 TAYLOR AVE
RACINE, WI 53403-2405
Phone number: 262-638-6635
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