Provider Demographics
NPI:1124521414
Name:JASTROW, BRANDY N (LCSW)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:N
Last Name:JASTROW
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 1:1635 MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3610
Mailing Address - Country:US
Mailing Address - Phone:715-685-5400
Mailing Address - Fax:715-685-5102
Practice Address - Street 1:PO BOX 396
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-0396
Practice Address - Country:US
Practice Address - Phone:715-478-4339
Practice Address - Fax:715-478-4494
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130878-121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI130878-121OtherSTATE LICENSE