Provider Demographics
NPI:1124584255
Name:VAHOVICK, JESSICA NICHOLE (LPC-IT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOLE
Last Name:VAHOVICK
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:NICHOLE
Other - Last Name:MEWHORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8032 W BEACON HILL DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8979
Mailing Address - Country:US
Mailing Address - Phone:414-305-2584
Mailing Address - Fax:
Practice Address - Street 1:8032 W BEACON HILL DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-8979
Practice Address - Country:US
Practice Address - Phone:414-305-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4187-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4187-226OtherLICENSE