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1952403966
VERNON WAYNE FORMAN
PORT WASHINGTON, WI
NPI
1952403966
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI 1701)
Enumeration Date
2006-09-01
Last Update Date
2007-07-08
Business Address
Mr. VERNON WAYNE FORMAN Certifications
722 S SPRING ST
PORT WASHINGTON, WI 53074-2334
Phone number: 262-483-0048
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Mailing Address
Mr. VERNON WAYNE FORMAN Certifications
722 S SPRING ST
PORT WASHINGTON, WI 53074-2334
Phone number: 262-483-0048
Copy
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