Individual
MR. JASEN ALAN EBERHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC-IT
Contact information
Practice address
223 WISCONSIN AVE STE B, WAUKESHA, WI 53186-4968
(262) 701-7257
Mailing address
223 WISCONSIN AVE STE B, WAUKESHA, WI 53186-4968
(262) 701-7257
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18552-130
WI
Other
Enumeration date
07/30/2018
Last updated
07/30/2018
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