Provider Demographics
NPI:1003246943
Name:RUPNIK, JACQUELYN (LPC-WI-4813-125)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:RUPNIK
Suffix:
Gender:F
Credentials:LPC-WI-4813-125
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W4051 COUNTY ROAD NN
Mailing Address - Street 2:P.O. BOX 1005
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4338
Mailing Address - Country:US
Mailing Address - Phone:262-741-3200
Mailing Address - Fax:
Practice Address - Street 1:W4051 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4338
Practice Address - Country:US
Practice Address - Phone:262-741-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4813-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional