Healthcare Provider Details

I. General information

NPI: 1396662300
Provider Name (Legal Business Name): JENA L HENRY CISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10186 COUNTY ROAD MM
AMHERST JUNCTION WI
54407-9053
US

IV. Provider business mailing address

10186 COUNTY ROAD MM
AMHERST JUNCTION WI
54407-9053
US

V. Phone/Fax

Practice location:
  • Phone: 218-213-0953
  • Fax:
Mailing address:
  • Phone: 218-213-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3001024862
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: