Healthcare Provider Details

I. General information

NPI: 1811495294
Provider Name (Legal Business Name): JENNA HESSE LCSW, SAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7327 ANDERSON AVE
SHAWANO WI
54166-1143
US

IV. Provider business mailing address

504 LAKELAND RD
SHAWANO WI
54166-3836
US

V. Phone/Fax

Practice location:
  • Phone: 715-526-4700
  • Fax: 715-526-5542
Mailing address:
  • Phone: 715-526-4700
  • Fax: 715-526-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129973-121
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number129973-121
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9263-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: