Individual
DALE R HERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
3506 N US HIGHWAY 51, JANESVILLE, WI 53545-0726
(608) 757-5373
(608) 758-8428
Mailing address
4305 TYDL DR, JANESVILLE, WI 53546-2116
(608) 757-5373
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2028 123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39195400
—
WI
Enumeration date
03/01/2007
Last updated
07/09/2007
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