Provider Demographics
NPI:1508882366
Name:HUSSLEIN, JO ANN (LPC)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:HUSSLEIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 STATE ROAD 144
Mailing Address - Street 2:
Mailing Address - City:SLINGER
Mailing Address - State:WI
Mailing Address - Zip Code:53086-9526
Mailing Address - Country:US
Mailing Address - Phone:262-644-1161
Mailing Address - Fax:262-787-2909
Practice Address - Street 1:12970 W BLUEMOUND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-787-2904
Practice Address - Fax:262-787-2909
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3353-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40967300Medicaid