Provider Demographics
NPI:1861228934
Name:RADEMACHER, JACOB DANIEL
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DANIEL
Last Name:RADEMACHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 WILLIAMSON ST APT 241
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-4642
Mailing Address - Country:US
Mailing Address - Phone:262-470-9493
Mailing Address - Fax:
Practice Address - Street 1:730 WILLIAMSON ST APT 241
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4642
Practice Address - Country:US
Practice Address - Phone:262-470-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8049-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor