Healthcare Provider Details

I. General information

NPI: 1043769193
Provider Name (Legal Business Name): JASMINE WEBSTER LCSW, LMFT-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 N PROSPECT AVE STE 450
MILWAUKEE WI
53202-6333
US

IV. Provider business mailing address

11241 SYNERGY DR APT 350
WAUWATOSA WI
53222-1345
US

V. Phone/Fax

Practice location:
  • Phone: 262-236-5547
  • Fax:
Mailing address:
  • Phone: 414-737-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number106H00000X
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149023933
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9603-123
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: