Healthcare Provider Details

I. General information

NPI: 1033263520
Provider Name (Legal Business Name): JODI MARIE MARSH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI MARIE KWIATKOWSKI LPC

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15397 STATE HIGHWAY 32 NORTHERN HEALTH CENTERS, INC.
LAKEWOOD WI
54138-9702
US

IV. Provider business mailing address

12980 COUNTY ROAD D
LAC DU FLAMBEAU WI
54538-9709
US

V. Phone/Fax

Practice location:
  • Phone: 715-276-6321
  • Fax: 715-276-1428
Mailing address:
  • Phone: 715-892-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3675125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: