MEDICARE: JANICE SUSAN O'CONNOR M.S.W., L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	344-123	WI

General Provider Information

NPI Number	:	1518000314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE SUSAN O'CONNOR M.S.W., L.C.S.W.

Provider Business Mailing Address
First Line	:	4330 GOLF TER STE 214
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-4688
Country	:	US
Telephone Number	:	715-832-4060
Fax Number	:	844-829-0296

Provider Business Practice Location Address
First Line	:	4330 GOLF TER STE 214
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-4688
Country	:	US
Telephone Number	:	715-832-4060
Fax Number	:	844-829-0296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	01/16/2018

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