Healthcare Provider Details

I. General information

NPI: 1386554939
Provider Name (Legal Business Name): JESSICA GUENTHER LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RIVERSIDE DR STE 6
GREEN BAY WI
54301-1957
US

IV. Provider business mailing address

2301 RIVERSIDE DR STE 6
GREEN BAY WI
54301-1957
US

V. Phone/Fax

Practice location:
  • Phone: 920-772-8711
  • Fax:
Mailing address:
  • Phone: 920-772-8711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9251226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: