Provider Demographics
NPI:1457421000
Name:FAACKS, JANE H (LPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:H
Last Name:FAACKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ANNE
Other - Last Name:HELSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1320 W CLAIREMONT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4566
Mailing Address - Country:US
Mailing Address - Phone:715-834-2046
Mailing Address - Fax:715-834-7563
Practice Address - Street 1:3136 CRAIG RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6109
Practice Address - Country:US
Practice Address - Phone:715-838-9856
Practice Address - Fax:715-838-7289
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2619-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40971600Medicaid