| NPI | 1831419324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA LYNN BECKETT Clinic Administrator 608-617-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WI 3590-125) |
| Enumeration Date | 2010-06-07 |
| Last Update Date | 2010-06-07 |