Basic Information
| Provider Information | |||||||||
| NPI: | 1720100688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANROSSUM | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | W283 N6297 HIBRITTEN WAY | ||||||||
| Address2: | |||||||||
| City: | HARTLAND | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7735021023 | ||||||||
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| Practice Location | |||||||||
| Address1: | 741 N GRAND AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531864820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625423255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3614-125 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.