NPI 1487720769 · live from the CMS NPI Registry
Randall John Ambrosius, MSW CADCIII LCSW
Counselor, Addiction (Substance Use Disorder) in Wisconsin Rapids, WI. National Provider Identifier 1487720769, active.
NPI record
| NPI | 1487720769 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Counselor, Addiction (Substance Use Disorder) 101YA0400X |
| Practice location | 2611 12th St S, Mental Health Aoda Clinic, Wisconsin Rapids, WI 54494 |
| Practice phone | 715-421-8849 |
| Mailing address | 2611 12th St S, Wisconsin Rapids, WI 54494 |
| Enumerated | November 28, 2006 |
| Last updated | January 29, 2008 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Addiction (Substance Use Disorder) primary | 101YA0400X | 1834 (WI) |
| Social Worker, Clinical | 1041C0700X | 4186123 (WI) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.