Healthcare Provider Details

I. General information

NPI: 1376377259
Provider Name (Legal Business Name): JESSICA BADOUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FORDEM AVE
MADISON WI
53704-4600
US

IV. Provider business mailing address

1506 SHERIDAN DR
MADISON WI
53704-3834
US

V. Phone/Fax

Practice location:
  • Phone: 608-455-6070
  • Fax: 608-455-0883
Mailing address:
  • Phone: 262-215-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12814-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: