MR. Jack George Rudolph

NPI #1487823308 in Medford, Wisconsin

Provider Information

NPI Number: 1487823308
Entity Type: Individual
Name: MR. Jack George Rudolph
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Enumeration Date: Feb 25, 2008
Last Updated: Mar 13, 2008

Practice Location

Address: 540 COLLEGE AVE
City: Medford
State: Wisconsin
ZIP Code: 54451-2027
Phone: (715) 748-3332

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary

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