Individual
MR. JACOB EDWARD STRUHELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CLINICAL SUBSTANCE A
Contact information
Practice address
3301 N BALLARD RD STE B, APPLETON, WI 54911-9002
(920) 733-4443
(920) 733-4796
Mailing address
3301 N BALLARD RD STE B, APPLETON, WI 54911-9002
(920) 733-4443
(920) 733-4796
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15257132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42018000
—
WI
Enumeration date
05/10/2007
Last updated
07/10/2012
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