Individual
JACK BASTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1155 N ELM ST STE 120, PLATTEVILLE, WI 53818-1207
(608) 348-4060
Mailing address
1155 N ELM ST STE 120, PLATTEVILLE, WI 53818-1207
(608) 348-4060
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/08/2019
Last updated
02/08/2019
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