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General NPI Number Information
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NPI Number | 1396222345
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Entity Type | Individual
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Provider Name | CYNTHIA JOAN JURISHICA LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 06/07/2024
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Provider Practice Location Address
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Address Line | 710 N WEBB AVE
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City | REEDSBURG
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State | WI
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Zip | 53959-1149
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Country | US
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Telephone | 608-524-5151
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Fax | 608-524-5353
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Provider Business Mailing Address
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Address Line | W5750 FISH CT
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City | MONTELLO
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State | WI
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Zip | 53949-7862
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Country | US
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Telephone | 715-897-4158
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2053
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 2053-123
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License Number State | WI
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