Provider Demographics
NPI:1720217482
Name:WISNESKI, JANE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ELIZABETH
Last Name:WISNESKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:WISNESKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:821 E 1ST AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1586
Mailing Address - Country:US
Mailing Address - Phone:920-364-9655
Mailing Address - Fax:920-364-9655
Practice Address - Street 1:821 E 1ST AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1586
Practice Address - Country:US
Practice Address - Phone:920-364-9655
Practice Address - Fax:920-364-9655
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4615-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional