Provider Demographics
NPI:1528034345
Name:GRAHL, JEANNA J (MSE, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JEANNA
Middle Name:J
Last Name:GRAHL
Suffix:
Gender:F
Credentials:MSE, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-0321
Mailing Address - Country:US
Mailing Address - Phone:920-743-4428
Mailing Address - Fax:920-743-4681
Practice Address - Street 1:50 S MADISON AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-2742
Practice Address - Country:US
Practice Address - Phone:920-743-4428
Practice Address - Fax:920-743-4681
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2924-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43569500Medicaid