Provider Demographics
NPI:1558991075
Name:ARCHAMBEAU, JORDYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JORDYN
Middle Name:
Last Name:ARCHAMBEAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 W SPENCER ST STE 1030
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-4352
Mailing Address - Country:US
Mailing Address - Phone:920-382-7764
Mailing Address - Fax:
Practice Address - Street 1:2999 W SPENCER ST STE 1030
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-4352
Practice Address - Country:US
Practice Address - Phone:920-382-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9933-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health