Provider Demographics
NPI:1891067443
Name:MANDERSCHEID, JENNIFER SWEENEY (MS, LPC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SWEENEY
Last Name:MANDERSCHEID
Suffix:
Gender:F
Credentials:MS, LPC, CSAC
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Mailing Address - Street 1:6040 W LISBON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2116
Mailing Address - Country:US
Mailing Address - Phone:414-871-9111
Mailing Address - Fax:414-871-9121
Practice Address - Street 1:6040 W LISBON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2116
Practice Address - Country:US
Practice Address - Phone:414-871-9111
Practice Address - Fax:414-871-9121
Is Sole Proprietor?:No
Enumeration Date:2012-01-29
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI16479-130101YA0400X
WI1298-226101YM0800X
WI5843-132101YA0400X
WI5283-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)