Provider Demographics
NPI:1184690679
Name:DAUTE, JEAN A (MS LPC CSAC ICS MAC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:A
Last Name:DAUTE
Suffix:
Gender:F
Credentials:MS LPC CSAC ICS MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2100
Mailing Address - Country:US
Mailing Address - Phone:608-873-7838
Mailing Address - Fax:877-674-2177
Practice Address - Street 1:135 W MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:STOUGHTON
Practice Address - State:WI
Practice Address - Zip Code:53589-2100
Practice Address - Country:US
Practice Address - Phone:608-873-7838
Practice Address - Fax:877-674-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1453101YA0400X
WI3118-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39335400Medicaid