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General NPI Number Information
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NPI Number | 1508390469
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Entity Type | Organization
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Legal Business Name | JSR THERAPEUTIC CONSULTING
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 1370 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-637-4089
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Fax | 866-491-1465
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Provider Business Mailing Address
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Address Line | 1370 S COMMERCIAL ST
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City | NEENAH
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State | WI
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Zip | 54956-4636
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Country | US
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Telephone | 920-637-4089
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Fax | 866-491-1465
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Authorized Official
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Title or Position | OWNER
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Name | JEFF RYAN
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Credential | LPC,CSAC,CSIT
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Telephone | 920-637-4089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 5280-125
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License Number State | WI
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