JASON W LATVA

SHAWANO, WI
NPI1952744161
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: WI  15923-131)
Enumeration Date2013-04-08
Last Update Date2015-03-11
Business Address
-- JASON W LATVA SAC
504 LAKELAND RD
SHAWANO, WI 54166-3836
Phone number: 715-524-6873
Mailing Address
-- JASON W LATVA SAC
504 LAKELAND RD
SHAWANO, WI 54166-3836
Phone number: 715-524-6873
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