Provider Demographics
NPI:1851080451
Name:MOSSNER, JENNA
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:
Last Name:MOSSNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:KIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6219 CANYON PKWY
Mailing Address - Street 2:
Mailing Address - City:MCFARLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53558-8787
Mailing Address - Country:US
Mailing Address - Phone:317-645-6959
Mailing Address - Fax:
Practice Address - Street 1:6219 CANYON PKWY
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:WI
Practice Address - Zip Code:53558-8787
Practice Address - Country:US
Practice Address - Phone:317-645-6959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009315A1041C0700X
WI101391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical