Healthcare Provider Details

I. General information

NPI: 1366604357
Provider Name (Legal Business Name): JANE LAURIE COLEMAN MSE,LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

IV. Provider business mailing address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-5547
  • Fax: 715-526-5542
Mailing address:
  • Phone: 715-526-5547
  • Fax: 715-526-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3087-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: