Provider Demographics
NPI:1003048158
Name:LEPAK-JOSTSONS, INC.
Entity Type:Organization
Organization Name:LEPAK-JOSTSONS, INC.
Other - Org Name:DYNAMIC FAMILY SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEPAK-JOSTSONS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT,CSAC,AAMFT
Authorized Official - Phone:920-323-2188
Mailing Address - Street 1:615 S 8TH ST
Mailing Address - Street 2:STE. 210
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4463
Mailing Address - Country:US
Mailing Address - Phone:920-323-7431
Mailing Address - Fax:920-358-5970
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:STE 220
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-323-7431
Practice Address - Fax:920-358-5970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2869261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2869Medicaid