Individual
JESSICA G KERCKHOVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, SAC
Contact information
Practice address
320 21ST ST N, MENOMONIE, WI 54751-2228
(715) 235-4537
Mailing address
5533 166TH ST, CHIPPEWA FALLS, WI 54729-6916
(715) 559-4563
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15453-131
WI
Other
Enumeration date
12/09/2008
Last updated
12/09/2008
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