Individual
MS. JEWELL MARIE BREITENGROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
1407 SAINT ANDREW ST, SUITE 100, LA CROSSE, WI 54603-3301
(608) 785-5576
(608) 785-6315
Mailing address
611 23RD ST N, LA CROSSE, WI 54601-3853
(608) 796-0146
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
5337-120
WI
Other
Enumeration date
03/28/2007
Last updated
07/08/2007
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