Provider Demographics
NPI:1639934649
Name:PAGET, JESSICA LEE (SAC-IT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:PAGET
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:NIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S76W16851 GREGORY DR APT G
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-8670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9401 W BELOIT RD STE 201
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53227-4357
Practice Address - Country:US
Practice Address - Phone:414-775-2677
Practice Address - Fax:414-775-2734
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20498-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty