Provider Demographics
NPI:1114074499
Name:(CHRISTIANSON) PREY, JO NEL MARIE
Entity Type:Individual
Prefix:MS
First Name:JO NEL
Middle Name:MARIE
Last Name:(CHRISTIANSON) PREY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JO NEL
Other - Middle Name:MARIE
Other - Last Name:PREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSE,LPC
Mailing Address - Street 1:845 HERITAGE TRL
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-8009
Mailing Address - Country:US
Mailing Address - Phone:920-233-4464
Mailing Address - Fax:
Practice Address - Street 1:2380 STATE ROAD 44
Practice Address - Street 2:SUITE A
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-6442
Practice Address - Country:US
Practice Address - Phone:920-230-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI488-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional