Individual
JESSICA KOLUCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
N11893 12TH AVE, NECEDAH, WI 54646-7528
(608) 548-2342
Mailing address
N11893 12TH AVE, NECEDAH, WI 54646-7528
(608) 548-2342
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
0014118
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014118
ADULT FAMILY HOME LICENSE #0014118
WI
Enumeration date
10/01/2012
Last updated
10/01/2012
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