Provider Demographics
NPI:1306076096
Name:WANGERIN, JENNIFER E (LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:E
Last Name:WANGERIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:HAHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 KESSEL COURT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-6275
Mailing Address - Country:US
Mailing Address - Phone:608-280-2675
Mailing Address - Fax:608-280-2707
Practice Address - Street 1:25 KESSEL CT STE 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-6227
Practice Address - Country:US
Practice Address - Phone:608-280-2700
Practice Address - Fax:608-280-2707
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5421-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1306076096OtherNPI