Provider Demographics
NPI:1629550116
Name:KWAPIL, JENNIFER W (LPC, SAC IT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:KWAPIL
Suffix:
Gender:F
Credentials:LPC, SAC IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3220
Mailing Address - Country:US
Mailing Address - Phone:920-248-6845
Mailing Address - Fax:
Practice Address - Street 1:1315 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53094-3564
Practice Address - Country:US
Practice Address - Phone:920-261-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18432-130101YA0400X
WI7042-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)