Provider Demographics
NPI:1710135413
Name:JONET, BRYAN ROBERT (LPC)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ROBERT
Last Name:JONET
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 1:2339 CEDAR RDG
Mailing Address - Street 2:SUTIE 4
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5700
Mailing Address - Country:US
Mailing Address - Phone:920-497-6161
Mailing Address - Fax:920-498-0476
Practice Address - Street 1:2339 CEDAR RDG
Practice Address - Street 2:SUTIE 4
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5700
Practice Address - Country:US
Practice Address - Phone:920-497-6161
Practice Address - Fax:920-498-0476
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3705-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43737900Medicaid