Provider Demographics
NPI:1962816371
Name:HESSE, JOELLE M (SAC)
Entity Type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:M
Last Name:HESSE
Suffix:
Gender:F
Credentials:SAC
Other - Prefix:MS
Other - First Name:JOELLE
Other - Middle Name:M
Other - Last Name:DOMINGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SACT
Mailing Address - Street 1:630 CHERRY STREET
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-435-2093
Mailing Address - Fax:920-435-2580
Practice Address - Street 1:630 CHERRY ST.
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-435-2093
Practice Address - Fax:920-435-2580
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17029-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)