Healthcare Provider Details

I. General information

NPI: 1033466958
Provider Name (Legal Business Name): JANE F WILKA-PAULY LADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 10/28/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 34TH AVE EAST
ALEXANDRIA MN
56308
US

IV. Provider business mailing address

980 S TOWER RD
FERGUS FALLS MN
56537-5505
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number302642
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number00893
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: