Provider Demographics
NPI:1083831846
Name:STARKEY MUNSON, JENNIFER A (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:STARKEY MUNSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 STEWART AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4162
Mailing Address - Country:US
Mailing Address - Phone:715-848-0525
Mailing Address - Fax:715-848-8665
Practice Address - Street 1:2620 STEWART AVE STE 310
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4162
Practice Address - Country:US
Practice Address - Phone:715-848-0525
Practice Address - Fax:715-848-8665
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI637-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43595900Medicaid