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General NPI Number Information
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NPI Number | 1770144297
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Entity Type | Individual
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Provider Name | JILL PLAISTED
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Gender | Female
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 8503 75TH STREET SUITE A
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158
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Country | US
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Telephone | 262-287-4428
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Fax |
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Provider Business Mailing Address
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Address Line | 8503 75TH ST STE A
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City | KENOSHA
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State | WI
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Zip | 53142-7620
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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