Individual
JEROME MUTCHIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
1000 N LYNNDALE DR, C, APPLETON, WI 54914-3057
(920) 735-9010
(920) 735-9050
Mailing address
1000 N LYNNDALE DR, C, APPLETON, WI 54914-3057
(920) 735-9010
(920) 735-9050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16720-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15933-131
STATE LICENSE
WI
Enumeration date
10/11/2012
Last updated
11/25/2014
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