Provider Demographics
NPI:1568217255
Name:JASKE, RHEANNA (LPC-IT, NCC)
Entity Type:Individual
Prefix:
First Name:RHEANNA
Middle Name:
Last Name:JASKE
Suffix:
Gender:F
Credentials:LPC-IT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 N GRANDVIEW BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1690
Mailing Address - Country:US
Mailing Address - Phone:262-313-8339
Mailing Address - Fax:
Practice Address - Street 1:2607 N GRANDVIEW BLVD STE 110
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1690
Practice Address - Country:US
Practice Address - Phone:414-507-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7830-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor