Individual
JOLENE A DERFUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
3144 VANZILE RD, CRANDON, WI 54520-8149
(715) 478-5180
Mailing address
4851 HAM LAKE RD, WABENO, WI 54566-9084
(715) 850-1707
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
19242
WI
Other
Enumeration date
07/09/2021
Last updated
07/09/2021
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