Individual
PHABIAN TREYVONNE DEJEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 W 4TH ST, KAUKAUNA, WI 54130-2447
(920) 809-1023
Mailing address
104 W 4TH ST, KAUKAUNA, WI 54130-2447
(920) 809-1023
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
0019259
WI
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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