Provider Demographics
NPI:1841648839
Name:BURKEL, JENNIFER LEA (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEA
Last Name:BURKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:COUILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 WEST WASHIGHTON AVENUE, SUITE 630
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703
Mailing Address - Country:US
Mailing Address - Phone:608-424-8411
Mailing Address - Fax:
Practice Address - Street 1:122 W WASHINGTON AVE STE 630
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2758
Practice Address - Country:US
Practice Address - Phone:608-424-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9360-1231041C0700X
WI129635-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker