Provider Demographics
NPI:1932590916
Name:THERING, JESSICA ROSE (SAC-IT, MT-BC, WMTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ROSE
Last Name:THERING
Suffix:
Gender:F
Credentials:SAC-IT, MT-BC, WMTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2102
Mailing Address - Country:US
Mailing Address - Phone:262-377-6276
Mailing Address - Fax:
Practice Address - Street 1:1971 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2102
Practice Address - Country:US
Practice Address - Phone:262-377-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI117101Y00000X
WI17328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor