Individual
JERRETT JAY FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC-IT, CNA
Contact information
Practice address
1681 N PROSPECT AVE, MILWAUKEE, WI 53202-6720
(414) 273-8484
Mailing address
1681 N PROSPECT AVE, MILWAUKEE, WI 53202-6720
(414) 273-8484
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18199-130
WI
Other
Enumeration date
06/15/2017
Last updated
07/21/2022
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