Provider Demographics
NPI:1740998152
Name:WRIGHT, JEFFREY DAVID (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E4235 THERON LN
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-5010
Mailing Address - Country:US
Mailing Address - Phone:715-797-1247
Mailing Address - Fax:
Practice Address - Street 1:2128 EASTRIDGE CTR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3403
Practice Address - Country:US
Practice Address - Phone:715-579-1430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7354-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical