Provider Demographics
NPI:1144778705
Name:HOTTENSTEIN, JAYNE (CSAC)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:HOTTENSTEIN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:
Other - Last Name:OURS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1971 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2122
Mailing Address - Country:US
Mailing Address - Phone:262-377-6276
Mailing Address - Fax:
Practice Address - Street 1:1622 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3014
Practice Address - Country:US
Practice Address - Phone:262-306-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16277101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)