Provider Demographics
NPI:1174183446
Name:VAN LAARHOVEN, JACQUELYN (MS, LPC, SAC-IT)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:VAN LAARHOVEN
Suffix:
Gender:F
Credentials:MS, LPC, SAC-IT
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:SIRIANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC-IT
Mailing Address - Street 1:6304 KELLY PL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4397
Mailing Address - Country:US
Mailing Address - Phone:715-571-0649
Mailing Address - Fax:715-679-3080
Practice Address - Street 1:6304 KELLY PL
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4397
Practice Address - Country:US
Practice Address - Phone:715-571-0649
Practice Address - Fax:715-679-3080
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI8364125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health