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General NPI Number Information
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NPI Number | 1336951771
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Entity Type | Individual
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Provider Name | JENNIFER R VICKERS
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 145 W WISCONSIN AVE
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City | NEENAH
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State | WI
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Zip | 54956-3075
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Country | US
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Telephone | 920-725-1230
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Fax |
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Provider Business Mailing Address
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Address Line | 1685 DRUM CORPS DR APT 5
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City | MENASHA
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State | WI
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Zip | 54952-1368
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Country | US
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Telephone | 920-213-3880
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 8240226
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License Number State | WI
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