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General NPI Number Information
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NPI Number | 1174952352
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Entity Type | Individual
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Provider Name | JANELLE KATHLEEN HAFERMANN LPC, CSAC, ICS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 320 W GRAND AVE STE 204
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54495-2781
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Country | US
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Telephone | 715-421-1107
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Fax | 715-421-1108
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Provider Business Mailing Address
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Address Line | 820 TWO MILE AVE
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City | WISCONSIN RAPIDS
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State | WI
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Zip | 54494-6661
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Country | US
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Telephone | 715-421-1107
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Fax | 715-421-1108
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15834-132
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10484-125
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10484-125
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License Number State | WI
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