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General NPI Number Information
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NPI Number | 1992297568
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Entity Type | Individual
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Provider Name | LINDA JEANNE MARTENET LPC IT
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Gender | Female
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 12/20/2019
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Provider Practice Location Address
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Address Line | 400 W RIVER DR
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City | WEST BEND
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State | WI
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Zip | 53090-1518
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Country | US
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Telephone | 262-334-4340
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Fax | 262-334-4341
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Provider Business Mailing Address
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Address Line | 1122 HICKORY ST APT 6
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City | GRAFTON
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State | WI
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Zip | 53024-1134
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Country | US
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Telephone | 262-808-6525
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 7612-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3872-226
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License Number State | WI
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