Healthcare Provider Details
I. General information
NPI: 1598711699
Provider Name (Legal Business Name): JENNIFER L. CILINO-FOLKS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/26/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
515 22ND AVENUE MONROE CLINIC
MONROE WI
53566-1569
US
IV. Provider business mailing address
515 22ND AVE
MONROE WI
53566-1569
US
V. Phone/Fax
- Phone: 608-324-2222
- Fax:
- Phone:
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 103T00000X |
| Taxonomy | Psychologist |
| License Number | 071006887 |
| License Number State | IL |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103TC0700X |
| Taxonomy | Clinical Psychologist |
| License Number | 3548-57 |
| License Number State | WI |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: