Healthcare Provider Details

I. General information

NPI: 1699549337
Provider Name (Legal Business Name): JESSI EDITH ALTMANN ATR-P, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 RAYOVAC DRIVE SUITE 320
MADISON WI
54711
US

IV. Provider business mailing address

465 HUNTERS GLEN LN
JOHNSON CREEK WI
53038-9484
US

V. Phone/Fax

Practice location:
  • Phone: 608-520-0846
  • Fax:
Mailing address:
  • Phone: 608-501-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7523226
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11584
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-290
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: