Provider Demographics
NPI:1659078343
Name:JUREWICZ, ANISSA MARIE (LPC-IT)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:MARIE
Last Name:JUREWICZ
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 N GRANDVIEW BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1690
Mailing Address - Country:US
Mailing Address - Phone:262-313-8339
Mailing Address - Fax:
Practice Address - Street 1:2900 N MENOMONEE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-4545
Practice Address - Country:US
Practice Address - Phone:414-930-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7382-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional