Healthcare Provider Details

I. General information

NPI: 1366354599
Provider Name (Legal Business Name): JENNIFER WINDSOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 DIPLOMA DR
BLACK RIVER FALLS WI
54615-7702
US

IV. Provider business mailing address

N2711 S BUCKHOLZ RD
ETTRICK WI
54627-8201
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-5315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number3001031340
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: