Healthcare Provider Details

I. General information

NPI: 1821424748
Provider Name (Legal Business Name): ANDREA L JANQUART MSC, LPC, CSAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 S PARK ST
MADISON WI
53715-1708
US

IV. Provider business mailing address

37 SHERMAN TERRACE UNIT 4
MADISON WI
53704
US

V. Phone/Fax

Practice location:
  • Phone: 608-282-8270
  • Fax: 608-287-5992
Mailing address:
  • Phone: 608-770-0762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16145-132
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6272-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: