Individual
MRS. JANE A WILLIQUETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CADCIII,CCSII
Contact information
Practice address
915 VIOLA AVE, OSHKOSH, WI 54901
(920) 231-1104
Mailing address
915 VIOLA AVE, OSHKOSH, WI 54901-2258
(920) 231-1104
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
#1421
WI
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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