Provider Demographics
NPI:1215744081
Name:HONIGMAN, JODIE
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:HONIGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 W BRANTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3415
Mailing Address - Country:US
Mailing Address - Phone:414-940-1549
Mailing Address - Fax:
Practice Address - Street 1:11516 N PORT WASHINGTON RD STE 208
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3441
Practice Address - Country:US
Practice Address - Phone:262-518-0094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8229-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional