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Individual

JORDAN ROBERT YAKICH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 853-6947
Mailing address
7833 STATE ROAD 38, CALEDONIA, WI 53108-9607
(262) 853-6947

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
WI
2279E0002X
Emergency Care Registered Respiratory Therapist
WI

Other

Enumeration date
12/17/2020
Last updated
12/17/2020
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