Provider Demographics
NPI:1659703551
Name:CLAUSIUS, JACQUELINE (CATS III)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:CLAUSIUS
Suffix:
Gender:F
Credentials:CATS III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3732 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3166
Mailing Address - Country:US
Mailing Address - Phone:414-290-0440
Mailing Address - Fax:
Practice Address - Street 1:3732 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-3166
Practice Address - Country:US
Practice Address - Phone:414-290-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA081638101YA0400X
WI1321-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649316910OtherDRUG MEDICAL