Provider Demographics
NPI:1659320430
Name:LOMBARDI, JAN CLIFFORD (LPC)
Entity Type:Individual
Prefix:MR
First Name:JAN
Middle Name:CLIFFORD
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6058 S CHESTNUT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PLATTEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53818-8947
Mailing Address - Country:US
Mailing Address - Phone:608-342-4853
Mailing Address - Fax:608-342-4810
Practice Address - Street 1:6058 S CHESTNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:PLATTEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53818-8947
Practice Address - Country:US
Practice Address - Phone:608-342-4853
Practice Address - Fax:608-342-4810
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4215-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI05635Medicaid