1245501345 NPI number — MRS. JENNIFER ELIZABETH STROM M.A., LPC

Table of content: MRS. JENNIFER ELIZABETH STROM M.A., LPC (NPI 1245501345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245501345 NPI number — MRS. JENNIFER ELIZABETH STROM M.A., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROM
Provider First Name:
JENNIFER
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245501345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 W. TOWNE SQUARE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEQUON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53092-5017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-241-5099
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 W TOWNE SQUARE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEQUON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53092-5017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-241-5099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  4722-125 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com