Individual
JACOB M LIBSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSW
Contact information
Practice address
5407 8TH AVE, KENOSHA, WI 53140-3715
(262) 564-0067
Mailing address
848 STATE ROAD 60, CEDARBURG, WI 53012-9216
(262) 375-6794
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/13/2007
Last updated
07/08/2007
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