Healthcare Provider Details

I. General information

NPI: 1396659397
Provider Name (Legal Business Name): JENNIFER ANN HARTLING SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E 5TH ST
SUPERIOR WI
54880-3709
US

IV. Provider business mailing address

2222 E 5TH ST
SUPERIOR WI
54880-3709
US

V. Phone/Fax

Practice location:
  • Phone: 715-392-1955
  • Fax:
Mailing address:
  • Phone: 715-392-1955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20084-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: