Provider Demographics
NPI:1396808127
Name:BRAND, JEANNE M (LPC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:BRAND
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 1:1035 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1260
Mailing Address - Country:US
Mailing Address - Phone:715-234-4313
Mailing Address - Fax:715-736-0194
Practice Address - Street 1:1035 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1260
Practice Address - Country:US
Practice Address - Phone:715-234-4313
Practice Address - Fax:715-736-0194
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3659-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43591500Medicaid