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General NPI Number Information
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NPI Number | 1538373022
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Entity Type | Organization
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Legal Business Name | TAYLOR COUNTY
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 540 COLLEGE AVE
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City | MEDFORD
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State | WI
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Zip | 54451-2027
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Country | US
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Telephone | 715-748-3332
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Fax | 715-748-3342
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Provider Business Mailing Address
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Address Line | 540 COLLEGE AVE
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City | MEDFORD
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State | WI
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Zip | 54451-2027
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Country | US
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Telephone | 715-748-3332
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Fax | 715-748-3342
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Authorized Official
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Title or Position | CERTIFIED SUBSTANCE ABUSE COUNSELOR
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Name | MS. KAREN SUE JACOBSON
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Credential | CADC III, IDP-AT
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Telephone | 715-748-3332
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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 | 11414
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License Number State | WI
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