Individual
MR. JAMES EDWARD SUBROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
201 N PINE ST, BURLINGTON, WI 53105-1935
(262) 767-0441
Mailing address
319 W STATE ST, BURLINGTON, WI 53105-1811
(262) 763-6688
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11645-130
WI
Other
Enumeration date
02/02/2012
Last updated
02/02/2012
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