Provider Demographics
NPI:1578638201
Name:HODGSON, JENNIFER L (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HODGSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61320 W FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRON RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54847-2600
Mailing Address - Country:US
Mailing Address - Phone:330-321-6489
Mailing Address - Fax:
Practice Address - Street 1:2207 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3708
Practice Address - Country:US
Practice Address - Phone:218-212-3435
Practice Address - Fax:218-234-2993
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE3771101YM0800X
MNCC03878101YM0800X
WI6790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health