Provider Demographics
NPI:1790333243
Name:MASTICK, JENNIFER L (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MASTICK
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:M
Other - Last Name:BUDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, ATR
Mailing Address - Street 1:1414 MACARTHUR RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-1318
Mailing Address - Country:US
Mailing Address - Phone:608-242-8334
Mailing Address - Fax:
Practice Address - Street 1:1414 MACARTHUR RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-1318
Practice Address - Country:US
Practice Address - Phone:608-242-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6649-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty