Provider Demographics
NPI:1104532175
Name:DEGNER, JESSICA (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DEGNER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1352 COUNTY ROAD F
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53178-9612
Mailing Address - Country:US
Mailing Address - Phone:414-233-8252
Mailing Address - Fax:
Practice Address - Street 1:223 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-4968
Practice Address - Country:US
Practice Address - Phone:262-701-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI112071041C0700X
WI111161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical