Provider Demographics
NPI:1033263520
Name:MARSH, JODI MARIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:MARIE
Last Name:MARSH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:KWIATKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12980 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-9709
Mailing Address - Country:US
Mailing Address - Phone:715-892-7157
Mailing Address - Fax:
Practice Address - Street 1:15397 STATE HIGHWAY 32
Practice Address - Street 2:NORTHERN HEALTH CENTERS, INC.
Practice Address - City:LAKEWOOD
Practice Address - State:WI
Practice Address - Zip Code:54138-9702
Practice Address - Country:US
Practice Address - Phone:715-276-6321
Practice Address - Fax:715-276-1428
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3675125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40967500Medicaid