Healthcare Provider Details

I. General information

NPI: 1952764706
Provider Name (Legal Business Name): JEANNE LOUTHER LPC, SAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

787 LOIS DR
SUN PRAIRIE WI
53590-1177
US

IV. Provider business mailing address

W11211 COUNTY ROAD G
BEAVER DAM WI
53916-9567
US

V. Phone/Fax

Practice location:
  • Phone: 608-299-9697
  • Fax: 608-478-5646
Mailing address:
  • Phone: 608-206-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6313-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16256
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: