Provider Demographics
NPI:1437549110
Name:RADOWSKI, JENNA (MS ATR LCPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:RADOWSKI
Suffix:
Gender:F
Credentials:MS ATR LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 W BOLIVAR AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2287
Mailing Address - Country:US
Mailing Address - Phone:414-331-6729
Mailing Address - Fax:
Practice Address - Street 1:8800 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-3743
Practice Address - Country:US
Practice Address - Phone:262-633-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11416101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health