Individual
JONATHAN KYLE IRISH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
2574 SUN VALLEY DR STE 207, DELAFIELD, WI 53018-2334
(619) 865-2113
Mailing address
N8093 LAKEVIEW RD, OCONOMOWOC, WI 53066-5517
(619) 865-2113
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6441-125
WI
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
6441-125
WI
Other
Enumeration date
04/08/2010
Last updated
12/28/2023
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