Provider Demographics
NPI:1518173772
Name:BEHRENS, JENNA LYNN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:BEHRENS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAPLE ST
Mailing Address - Street 2:# 303
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-4047
Mailing Address - Country:US
Mailing Address - Phone:262-689-0688
Mailing Address - Fax:
Practice Address - Street 1:7332 W STATE ST LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2766
Practice Address - Country:US
Practice Address - Phone:262-689-0688
Practice Address - Fax:262-252-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43733400Medicaid