Healthcare Provider Details

I. General information

NPI: 1629011697
Provider Name (Legal Business Name): JENNIFER L MUELLER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST STE 500
LA CROSSE WI
54601-0716
US

IV. Provider business mailing address

201 MAIN ST STE 500
LA CROSSE WI
54601-0716
US

V. Phone/Fax

Practice location:
  • Phone: 608-389-0514
  • Fax: 608-668-4006
Mailing address:
  • Phone: 608-389-0514
  • Fax: 608-668-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2703
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2703
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3569
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: