Provider Demographics
NPI:1982198198
Name:WAY, JESSI S (MS)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:S
Last Name:WAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JESSI
Other - Middle Name:S
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-4738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:715-298-6365
Practice Address - Street 1:530 GRANT ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-4738
Practice Address - Country:US
Practice Address - Phone:715-845-5493
Practice Address - Fax:715-298-6365
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3954-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty