Healthcare Provider Details

I. General information

NPI: 1649806159
Provider Name (Legal Business Name): JENNIFER HLAVA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

IV. Provider business mailing address

721 OXFORD AVE
EAU CLAIRE WI
54703-5212
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-7602
  • Fax: 715-831-5783
Mailing address:
  • Phone: 715-839-7602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6127
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: