Jacob J Lichman Jr., CSAC IDP/AT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Montello, WI
NPI 1306140967 · NPPES record last updated Dec 22, 2010
Key facts
- NPI
- 1306140967
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 1853-132 (WI)
- Practice address
- N3829 State Road 22
Montello, WI 53949-9049 - Phone
- (608) 297-2085
- Fax
- (608) 297-2426
- NPI assigned
- Dec 22, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1853-132 | WI | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Marquette Chemical Dependency Service | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 1853-132 | WI | Yes |
Addresses
Primary practice location
N3829 State Road 22
Montello, WI 53949-9049
Mailing address
PO Box 57
Montello, WI 53949-0057
Phone (608) 297-2085
Other names
- Jay J Lichman Jr.
Other providers in Montello, WI
- Callie L Jerome
- Sandra Jean Kaul
- Stephanie Klinger
- Ruth L Klonowski
- Margaret R Kraemer
- Allison Linzmeier
- Jessica Lloyd
- Erin J Logan
- Corazon B Loteyro
- Marquette Chemical Dependency Service
All providers in Montello, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.