Healthcare Provider Details

I. General information

NPI: 1174952352
Provider Name (Legal Business Name): JANELLE KATHLEEN HAFERMANN LPC, CSAC, ICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 TWO MILE AVE
WISCONSIN RAPIDS WI
54494-6661
US

IV. Provider business mailing address

820 TWO MILE AVE
WISCONSIN RAPIDS WI
54494-6661
US

V. Phone/Fax

Practice location:
  • Phone: 715-421-1107
  • Fax: 715-421-1108
Mailing address:
  • Phone: 715-421-1107
  • Fax: 715-421-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10484-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15834-132
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10484-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: