Individual
BRUCE DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SAC
Contact information
Practice address
4000 W SPENCER ST, APPLETON, WI 54914-4015
(920) 735-9010
(920) 735-9050
Mailing address
4000 W. SPENCER ST., APPLETON, WI 54914
(920) 735-9010
(920) 735-9050
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15538-131
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15538-131
SUBSTANCE ABUSE COUNSELOR LICENSE
WI
Enumeration date
03/29/2010
Last updated
03/29/2010
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