Individual
JOANNE LEE TULACHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
810 LINCOLN STREET, KEWAUNEE, WI 54216
(920) 388-7030
(920) 388-7044
Mailing address
810 LINCOLN STREET, KEWAUNEE, WI 54216
(920) 388-7030
(920) 388-7044
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15190132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39174200
—
WI
01
—
3949242490003
BCBS
WI
Enumeration date
08/23/2006
Last updated
07/08/2007
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