Provider Demographics
NPI:1760113179
Name:TELLIER, JAIMI LEE (LCSW, SAC-IT)
Entity Type:Individual
Prefix:
First Name:JAIMI
Middle Name:LEE
Last Name:TELLIER
Suffix:
Gender:F
Credentials:LCSW, SAC-IT
Other - Prefix:
Other - First Name:JAIMI
Other - Middle Name:LEE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1333 COLLEGE AVE STE M1
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1150
Mailing Address - Country:US
Mailing Address - Phone:414-775-2500
Mailing Address - Fax:
Practice Address - Street 1:1333 COLLEGE AVE STE M1
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-1150
Practice Address - Country:US
Practice Address - Phone:414-775-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18917-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)