Healthcare Provider Details

I. General information

NPI: 1063088045
Provider Name (Legal Business Name): JESSICA PLISZKA M.S., NCC, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/28/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 W NORTH AVE STE 312
WAUWATOSA WI
53226-2416
US

IV. Provider business mailing address

S81W17620 BRENNAN DR
MUSKEGO WI
53150-8028
US

V. Phone/Fax

Practice location:
  • Phone: 414-248-0064
  • Fax:
Mailing address:
  • Phone: 414-403-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4969226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: