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General NPI Number Information
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NPI Number | 1477187136
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Entity Type | Individual
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Provider Name | JENNIE MARIE LEPIEN LCSW,SAC-IT
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Gender | Female
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 175 E WISCONSIN AVE STE H
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City | OCONOMOWOC
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State | WI
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Zip | 53066-3057
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Country | US
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Telephone | 262-567-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 430 FIRST ST
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City | HARTFORD
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State | WI
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Zip | 53027-1204
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Country | US
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Telephone | 262-623-1691
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 18362-130
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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 | 9250-123
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License Number State | WI
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