| Organization Name: | RAEANN WICHLACZ |
| NPI Number: | 1508840992 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAEANN WICHLACZ (OWNER) |
| Mailing Address: | 106 Galvin Road Abbotsford |
| State: | WI US |
| Postal Code: | 54405 |
| Phone Number: | 7152230480 |
| Fax Number: | 7152231611 |
| NPI Enumeration Date: | 11/30/2005 |
| NPI Last Update Date: | 06/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 11042 |
| 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: | |