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General NPI Number Information
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NPI Number | 1447511183
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Entity Type | Individual
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Provider Name | JACKIE K. RICHTER CSAC
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Gender | Female
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Dates
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Enumeration Date | 05/30/2012
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 212 11TH ST S
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City | LA CROSSE
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State | WI
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Zip | 54601-4116
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Country | US
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Telephone | 608-392-9555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EAU CLAIRE
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State | WI
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Zip | 54702-1510
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Country | US
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Telephone | 715-838-3635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15750
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5179
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5179
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License Number State | WI
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