Provider Demographics
NPI:1407500192
Name:ROUNDS, JEANINE MARIE
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:MARIE
Last Name:ROUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E EAGLE FLATS PKWY APT 306
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-9204
Mailing Address - Country:US
Mailing Address - Phone:920-213-6029
Mailing Address - Fax:
Practice Address - Street 1:1710 LAWRENCE DR STE 200
Practice Address - Street 2:
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115-9195
Practice Address - Country:US
Practice Address - Phone:920-570-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional