Individual
JEFFREY GORDON RANDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW/MSSW
Contact information
Practice address
10 TOWER DR, SUN PRAIRIE, WI 53590-1239
(608) 825-3500
(608) 824-4918
Mailing address
10 TOWER DR, SUN PRAIRIE, WI 53590-1239
(608) 825-3500
(608) 824-4918
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8455-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780916577
—
WI
Enumeration date
02/04/2010
Last updated
09/28/2021
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