Provider Demographics
NPI:1598951832
Name:ALWARD, JENNIFER R (MA MFT AT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:ALWARD
Suffix:
Gender:F
Credentials:MA MFT AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54521
Mailing Address - Country:US
Mailing Address - Phone:715-781-7350
Mailing Address - Fax:
Practice Address - Street 1:1499 6TH ST
Practice Address - Street 2:INNOVATIVE COUNSELING, INC.
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-2252
Practice Address - Country:US
Practice Address - Phone:920-497-6161
Practice Address - Fax:920-498-0476
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43717500Medicaid