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1952744161
JASON W LATVA
SHAWANO, WI
NPI
1952744161
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WI 15923-131)
Enumeration Date
2013-04-08
Last Update Date
2015-03-11
Business Address
JASON W LATVA SAC
504 LAKELAND RD
SHAWANO, WI 54166-3836
Phone number: 715-524-6873
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Mailing Address
JASON W LATVA SAC
504 LAKELAND RD
SHAWANO, WI 54166-3836
Phone number: 715-524-6873
Copy
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