Provider Demographics
NPI:1831707264
Name:BAKER, JESSICA ANNE (PSYD, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:BRODZELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:313 LAKEVIEW DR APT 3
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1638
Mailing Address - Country:US
Mailing Address - Phone:715-340-7634
Mailing Address - Fax:
Practice Address - Street 1:20700 WATERTOWN RD STE 100
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1800
Practice Address - Country:US
Practice Address - Phone:262-933-4024
Practice Address - Fax:262-933-4038
Is Sole Proprietor?:No
Enumeration Date:2020-07-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8221-125101YP2500X
WI402057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional