Individual
MR. WALLACE EDWARD BRANDIES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC ICS
Contact information
Practice address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6635
(262) 638-6540
Mailing address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6635
(262) 638-6540
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15295-132
WI
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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