Individual
JEFFREY D RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
757 S MAIN ST, SUITE 8, FOND DU LAC, WI 54935-5739
(920) 731-9798
(920) 731-1097
Mailing address
W175N11120 STONEWOOD DR, GERMANTOWN, WI 53022-6511
(262) 345-5560
(262) 345-5531
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
15702-132
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15702-132
WI
Other
Enumeration date
11/15/2012
Last updated
11/16/2012
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