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General NPI Number Information
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NPI Number | 1710223177
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Entity Type | Individual
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Provider Name | JESSICA M OSMUNSON MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 123 N OAKLAND AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-2831
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Country | US
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Telephone | 920-973-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 955 S MAIN ST
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City | MISHICOT
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State | WI
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Zip | 54228-9528
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Country | US
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Telephone | 920-973-1008
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 983-124
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License Number State | WI
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