Healthcare Provider Details

I. General information

NPI: 1023949898
Provider Name (Legal Business Name): JENNIFER PODEWELTZ SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 E WINNEBAGO STREET
RHINELANDER WI
54501
US

IV. Provider business mailing address

1991 E WINNEBAGO STREET
RHINELANDER WI
54501
US

V. Phone/Fax

Practice location:
  • Phone: 715-362-5745
  • Fax:
Mailing address:
  • Phone: 715-362-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number21153-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: