Basic Information
| Provider Information | |||||||||
| NPI: | 1437549110 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADOWSKI | ||||||||
| FirstName: | JENNA | ||||||||
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| Credential: | MS ATR LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2035 W BOLIVAR AVE APT 3 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532212287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143316729 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8800 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 534063743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626333591 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2015 | ||||||||
| LastUpdateDate: | 07/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 11416 | MT | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.