Healthcare Provider Details

I. General information

NPI: 1982245536
Provider Name (Legal Business Name): LAURA JANE LITJENS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 1ST ST STE 270
NEW RICHMOND WI
54017-1770
US

IV. Provider business mailing address

433 1/2 SUMMIT AVE
EAU CLAIRE WI
54701-4805
US

V. Phone/Fax

Practice location:
  • Phone: 715-246-4840
  • Fax: 715-254-9459
Mailing address:
  • Phone: 715-864-8754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7122-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: