Provider Demographics
NPI:1093366890
Name:MCDONOUGH, JANETTE R (LPC)
Entity Type:Individual
Prefix:
First Name:JANETTE
Middle Name:R
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WATER ST TRLR 61
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5263
Mailing Address - Country:US
Mailing Address - Phone:815-261-8524
Mailing Address - Fax:
Practice Address - Street 1:47 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1564
Practice Address - Country:US
Practice Address - Phone:815-261-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5595101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional