Healthcare Provider Details

I. General information

NPI: 1396445185
Provider Name (Legal Business Name): JENNIFER LINSE MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SOUTH AVE # GB1-003
LA CROSSE WI
54601-5467
US

IV. Provider business mailing address

1900 SOUTH AVE # GB1-003
LA CROSSE WI
54601-5467
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-4780
  • Fax:
Mailing address:
  • Phone: 608-775-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124662
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14064
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2120-121
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12931-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: