Provider Demographics
NPI:1619346590
Name:JELINEK, JENIFER (LPC)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:JELINEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6310
Mailing Address - Country:US
Mailing Address - Phone:608-365-1244
Mailing Address - Fax:608-365-4097
Practice Address - Street 1:416 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6310
Practice Address - Country:US
Practice Address - Phone:608-365-1244
Practice Address - Fax:608-365-4097
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5333-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health