Individual
JACOB J LICHMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC IDP/AT
Contact information
Practice address
N3829 STATE ROAD 22, MONTELLO, WI 53949-9049
(608) 297-2085
(608) 297-2426
Mailing address
PO BOX 57, MONTELLO, WI 53949-0057
(608) 297-2085
(608) 297-2426
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1853-132
WI
Other
Enumeration date
12/22/2010
Last updated
12/22/2010
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