Provider Demographics
NPI:1215076815
Name:SEMENAS, JEFFREY MARK (MASTERS)
Entity type:Individual
Prefix:MS
First Name:JEFFREY
Middle Name:MARK
Last Name:SEMENAS
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 BLACKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-3605
Mailing Address - Country:US
Mailing Address - Phone:608-827-7743
Mailing Address - Fax:
Practice Address - Street 1:1614 BLACKWOOD CT
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-3605
Practice Address - Country:US
Practice Address - Phone:608-827-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI938-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health