Provider Demographics
NPI:1053840819
Name:JONASEN, AARON (LPT-IT, NCC)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:JONASEN
Suffix:
Gender:M
Credentials:LPT-IT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 E WILSON ST
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-2908
Mailing Address - Country:US
Mailing Address - Phone:563-920-1242
Mailing Address - Fax:
Practice Address - Street 1:2607 N GRANDVIEW BLVD STE 108
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1690
Practice Address - Country:US
Practice Address - Phone:262-548-9148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3164-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional