Healthcare Provider Details

I. General information

NPI: 1144580556
Provider Name (Legal Business Name): LAURA JANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 W PARK PL SUITE 100
MILWAUKEE WI
53224-3606
US

IV. Provider business mailing address

10850 W PARK PL SUITE 100
MILWAUKEE WI
53224-3606
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-1191
  • Fax: 414-359-1021
Mailing address:
  • Phone: 262-789-1191
  • Fax: 414-359-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4973-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: