Provider Demographics
NPI:1013328947
Name:JODARSKI, DEBRA (LPC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:JODARSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N4107 13TH LN
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-5361
Mailing Address - Country:US
Mailing Address - Phone:920-787-2725
Mailing Address - Fax:
Practice Address - Street 1:N4107 13TH LN
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5361
Practice Address - Country:US
Practice Address - Phone:920-787-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4990-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional