Healthcare Provider Details

I. General information

NPI: 1497329734
Provider Name (Legal Business Name): JENNA LYNNE MCGINNIS LP, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6479
  • Fax: 414-266-6989
Mailing address:
  • Phone: 414-266-6479
  • Fax: 414-266-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12571
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number104099-875
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: