Doctor Name: | MR. WILLIAM B WAUGH |
NPI Number: | 1265440143 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CSAC |
License Number: | 12970-132 |
Business Practice Address: | 5409 Everbodys Road Forest County Potawatomi Health & Wellness Center Crandon, WI - 54520 |
Business Phone Number: | 7154784300 |
Business Fax Number: | 7154784490 |
Mailing Address: | Po Box 396, 5409 Everybodys Road CRANDON |
State: | WI |
Postal Code: | 545200396 |
Phone Number: | 7154784300 |
Fax Number: | 7154784490 |
NPI Enumeration Date: | 08/04/2006 |
NPI Last Update Date: | 05/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 12970-132 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |