Provider Demographics
NPI:1396913943
Name:WIDUCH, JANN M (LPC)
Entity type:Individual
Prefix:MS
First Name:JANN
Middle Name:M
Last Name:WIDUCH
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 1:6233 DURAND AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4961
Mailing Address - Country:US
Mailing Address - Phone:262-554-8165
Mailing Address - Fax:262-554-8152
Practice Address - Street 1:6233 DURAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-554-8165
Practice Address - Fax:262-554-8152
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2767-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional