Provider Demographics
NPI:1760829170
Name:WILLIAMS, JENNIFER ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MUTSCHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-T
Mailing Address - Street 1:225 N BEAUMONT RD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:PRAIRIE DU CHIEN
Mailing Address - State:WI
Mailing Address - Zip Code:53821-1445
Mailing Address - Country:US
Mailing Address - Phone:608-326-0248
Mailing Address - Fax:608-326-4395
Practice Address - Street 1:225 N BEAUMONT RD
Practice Address - Street 2:SUITE 326
Practice Address - City:PRAIRIE DU CHIEN
Practice Address - State:WI
Practice Address - Zip Code:53821-1445
Practice Address - Country:US
Practice Address - Phone:608-326-0248
Practice Address - Fax:608-326-4395
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1800-226101YP2500X
WI6177-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12683710OtherCAQH
WI100035152Medicaid