Healthcare Provider Details

I. General information

NPI: 1265672455
Provider Name (Legal Business Name): MRS. JENNIFER SUE PLITZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S BARSTOW ST
EAU CLAIRE WI
54701-3642
US

IV. Provider business mailing address

120 S BARSTOW ST
EAU CLAIRE WI
54701-3642
US

V. Phone/Fax

Practice location:
  • Phone: 715-832-2221
  • Fax: 715-838-8423
Mailing address:
  • Phone: 715-832-2221
  • Fax: 715-838-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number373-226
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8577-120
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: