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General NPI Number Information
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NPI Number | 1265684344
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Entity Type | Individual
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Provider Name | BARBARA ANN JAX
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Gender | Female
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 1407 SAINT ANDREW ST STE 100
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City | LA CROSSE
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State | WI
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Zip | 54603-3301
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Country | US
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Telephone | 608-785-5856
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Fax | 608-785-6315
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Provider Business Mailing Address
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Address Line | 1407 SAINT ANDREW ST STE 100
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City | LA CROSSE
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State | WI
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Zip | 54603-3301
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Country | US
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Telephone |
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 1475-127
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License Number State | WI
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