Healthcare Provider Details

I. General information

NPI: 1952421190
Provider Name (Legal Business Name): ASHLAND AREA COUNCIL ON ALCOHOLISM AND OTHER DRUG ABUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MAIN ST W STE 305
ASHLAND WI
54806-1512
US

IV. Provider business mailing address

502 MAIN ST W STE 305
ASHLAND WI
54806-1512
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-5207
  • Fax: 715-682-5209
Mailing address:
  • Phone: 715-682-5207
  • Fax: 715-682-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number017067
License Number StateWI

VIII. Authorized Official

Name: SHANNON L. ESALA
Title or Position: OFFICE MANAGER
Credential:
Phone: 715-682-5207