Individual
MARY NAHWAHQUAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
W3272 WOLF RIVER DR, KESHENA, WI 54135-9202
(715) 799-3861
(715) 799-3517
Mailing address
PO BOX 280, KESHENA, WI 54135-0280
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15255-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100084797
—
WI
Enumeration date
05/08/2018
Last updated
05/09/2019
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