Ambrosius, Randall John
Ambrosius, Randall John is an individual health care provider with primary practice located at 2611 12Th St S Mental Health Aoda Clinic, Wisconsin Rapids WI 54494. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Ambrosius, Randall John can be contacted via phone (715) 421-8849.Contact Information
Primary practice address
2611 12Th St S Mental Health Aoda Clinic
Wisconsin Rapids WI 54494
Phone: (715) 421-8849
Fax: (715) 421-2266
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 1834 | Wisconsin |
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 4186123 | Wisconsin |
Profile Details
| NPI number | 1487720769 |
|---|---|
| LBN Legal business name | Ambrosius, Randall John |
| Credentials | MSW CADCIII LCSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 28th, 2006 |
| Last updated | Jan 29th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487720769 | NPPES |
| Wisconsin | MEDICAID | 39354800 |
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