Healthcare Provider Details

I. General information

NPI: 1861413130
Provider Name (Legal Business Name): MICHAEL JAWORSKI LPC, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 N GRANDVIEW BLVD SUITES 301 AND 110
WAUKESHA WI
53188-1675
US

IV. Provider business mailing address

285 N JANACEK RD
BROOKFIELD WI
53045-6102
US

V. Phone/Fax

Practice location:
  • Phone: 262-524-9416
  • Fax: 262-524-9434
Mailing address:
  • Phone: 262-641-9050
  • Fax: 262-641-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12447
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1206-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: