Individual
MR. RICHARD R. DETTLAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS,CSAC
Contact information
Practice address
514 RIVERVIEW AVE, WAUKESHA, WI 53188-3631
(262) 548-7666
(262) 548-7656
Mailing address
W168S7024 PARKLAND DR, MUSKEGO, WI 53150-9441
(414) 422-4707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1355
WI
Other
Enumeration date
01/10/2007
Last updated
12/10/2013
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