Provider Demographics
NPI:1154665206
Name:JESTER, BILLIE JO MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:BILLIE JO
Middle Name:MARIE
Last Name:JESTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 SAND LAKE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2456
Mailing Address - Country:US
Mailing Address - Phone:608-519-1400
Mailing Address - Fax:608-519-0446
Practice Address - Street 1:704 SAND LAKE RD STE 205
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2456
Practice Address - Country:US
Practice Address - Phone:608-519-1400
Practice Address - Fax:608-519-0446
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8438-123104100000X
WI127801-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100026804Medicaid