Provider Demographics
NPI:1194133470
Name:VAN SLEET, JENNIFER L (MA, PCT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VAN SLEET
Suffix:
Gender:F
Credentials:MA, PCT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LAMPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, PCT
Mailing Address - Street 1:2620 STEIN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2674
Mailing Address - Country:US
Mailing Address - Phone:715-836-0064
Mailing Address - Fax:715-836-0065
Practice Address - Street 1:2620 STEIN BLVD STE B
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2674
Practice Address - Country:US
Practice Address - Phone:715-836-0064
Practice Address - Fax:715-836-0065
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6169-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional