Healthcare Provider Details

I. General information

NPI: 1386729218
Provider Name (Legal Business Name): JENNIFER L TOEPFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/05/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 N GRAND AVE STE 302
WAUKESHA WI
53186-4841
US

IV. Provider business mailing address

N17W24222 RIVERWOOD DRIVE SUITE 170
PEWAUKEE WI
53188-1134
US

V. Phone/Fax

Practice location:
  • Phone: 262-999-3495
  • Fax: 262-821-6180
Mailing address:
  • Phone: 262-999-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15427-132
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8358-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: