person
Jerry W Sample, CADC
Addiction (Substance Use Disorder) Counselor in La Crosse, Wisconsin
NPI 1508806001

Jerry W Sample is an Addiction (Substance Use Disorder) Counselor based in La Crosse, WI and is specialized in Addiction (Substance Use Disorder). Jerry W Sample practices in La Crosse, WI and has the professional credentials of CADC. The NPI Number for Jerry W Sample is 1508806001 and holds a License No. 11750 (Wisconsin).

The current practice location address for Jerry W Sample is 1910 South Ave, La Crosse, WI and can be reached out via phone at 608-782-7300.

Location: 1910 South Ave, La Crosse, WI, 54601-5467
person
Provider Profile Details
NPI Number
1508806001
Provider Name
Jerry W Sample
Credential
CADC
Provider Entity Type
Individual
Gender
Male
Address
1910 South Ave, La Crosse, WI, 54601-5467
Phone Number
608-782-7300
Fax Number
Provider Enumeration Date
06/07/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
39393100 05 WI
institution
Provider Business Practice Location Address Details
Address
1910 South Ave
City
State
Zip
54601-5467
Phone Number
608-782-7300
Fax Number
person
Provider Business Mailing Address Details
Address
1910 South Ave
City
State
Zip
54601-5467
Phone Number
608-782-7300
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
11750 (Wisconsin)
Definition
Definition to come...
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