Provider Demographics
NPI:1740549021
Name:DORNER, JESSICA L (LPC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:DORNER
Suffix:
Gender:
Credentials:LPC
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4633 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4220
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1734
Practice Address - Street 1:4633 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4220
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1734
Is Sole Proprietor?:No
Enumeration Date:2012-05-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4432-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional