Individual
MRS. RAEANN WICHLACZ
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CADC III
Contact information
Practice address
106 GALVIN ROAD, ABBOTSFORD, WI 54405
(175) 223-0480
(715) 223-1611
Mailing address
106 GALVIN ROAD, P.O. BOX 447, ABBOTSFORD, WI 54405
(175) 223-0480
(715) 223-1611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39380400
—
WI
Enumeration date
05/18/2006
Last updated
07/09/2007
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