Healthcare Provider Details

I. General information

NPI: 1265364319
Provider Name (Legal Business Name): JAZMINE S MAHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 N MILWAUKEE ST STE 202
MILWAUKEE WI
53202-5872
US

IV. Provider business mailing address

N71W22585 GOOD HOPE RD
LISBON WI
53089-2228
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8958-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: