Doctor Name: | MRS. RAEANN WICHLACZ |
NPI Number: | 1942253315 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CADC III |
License Number: | 11042 |
Business Practice Address: | 106 Galvin Road Abbotsford, WI - 54405 |
Business Phone Number: | 1752230480 |
Business Fax Number: | 7152231611 |
Mailing Address: | 106 Galvin Road, P.o. Box 447 ABBOTSFORD |
State: | WI |
Postal Code: | 54405 |
Phone Number: | 1752230480 |
Fax Number: | 7152231611 |
NPI Enumeration Date: | 05/18/2006 |
NPI Last Update Date: | 07/09/2007 |
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: |