Provider Demographics
NPI:1376983676
Name:STREVELER, JACQUELINE J (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:J
Last Name:STREVELER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:J
Other - Last Name:KRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 118
Mailing Address - Street 2:PEACEFUL SOLUTIONS COUNSELING
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54402-0118
Mailing Address - Country:US
Mailing Address - Phone:715-675-3458
Mailing Address - Fax:715-675-7238
Practice Address - Street 1:741 N FIRST ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403
Practice Address - Country:US
Practice Address - Phone:715-675-3458
Practice Address - Fax:715-675-7238
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5310-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1376983676Medicaid