Individual
MR. RANDALL JOHN AMBROSIUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW CADCIII LCSW
Contact information
Practice address
2611 12TH ST S, MENTAL HEALTH AODA CLINIC, WISCONSIN RAPIDS, WI 54494
(715) 421-8849
(715) 421-2266
Mailing address
2611 12TH ST S, WISCONSIN RAPIDS, WI 54494
(715) 421-8849
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1834
WI
1041C0700X
Clinical Social Worker
4186123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39354800
—
WI
Enumeration date
11/28/2006
Last updated
01/29/2008
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