MEDICARE: MR. JACOB RICHARD WISKERCHEN JR. MFT, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	01270	NV

General Provider Information

NPI Number	:	1093073132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB RICHARD WISKERCHEN JR. MFT, NCC

Provider Business Mailing Address
First Line	:	418 CHENEY ST
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-0912
Country	:	US
Telephone Number	:	775-287-1099
Fax Number	:

Provider Business Practice Location Address
First Line	:	975 ROBERTA LN STE 104
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89431-6812
Country	:	US
Telephone Number	:	775-525-1616
Fax Number	:	775-201-0147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	09/03/2024

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