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General NPI Number Information
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NPI Number | 1508729294
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Entity Type | Individual
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Provider Name | JADE TANJUNG
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Gender | Female
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Dates
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Enumeration Date | 12/08/2025
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | N91W17194 APPLETON AVE STE 204
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-2083
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Country | US
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Telephone | 414-502-7780
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Fax |
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Provider Business Mailing Address
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Address Line | 2454 N 117TH ST
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City | WAUWATOSA
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State | WI
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Zip | 53226-1120
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5583125
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License Number State | WI
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