Individual
JOSEPH WHITE EAGLE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
S2845 WHITE EAGLE RD, BARABOO, WI 53913-9064
(608) 355-1240
(608) 355-9588
Mailing address
S2845 WHITE EAGLE RD, BARABOO, WI 53913-9064
(608) 355-1240
(608) 355-9588
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16099-131
WI
Other
Enumeration date
01/09/2014
Last updated
11/30/2016
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