Individual
JONATHAN PHILLIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
211 N COMMERCIAL ST, NEENAH, WI 54956-2616
(920) 236-4600
Mailing address
PO BOX 2187, OSHKOSH, WI 54903-2187
(920) 236-4600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
195-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42139300
—
WI
05
—
42156000
—
WI
Enumeration date
11/28/2006
Last updated
07/08/2007
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