Provider Demographics
NPI:1821552191
Name:JANSSEN, CARLENE (L AC)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5047 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54937-7727
Mailing Address - Country:US
Mailing Address - Phone:920-979-1080
Mailing Address - Fax:
Practice Address - Street 1:481 E DIVISION ST STE 200
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3775
Practice Address - Country:US
Practice Address - Phone:920-933-1040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI988-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist