Provider Demographics
NPI:1386751832
Name:LEPAK JOSTSONS, JANE A (MS, LMFT, AAMFT)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:LEPAK JOSTSONS
Suffix:
Gender:F
Credentials:MS, LMFT, AAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:926 S 8TH ST
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-1177
Mailing Address - Country:US
Mailing Address - Phone:920-683-4285
Mailing Address - Fax:920-683-4908
Practice Address - Street 1:926 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-1177
Practice Address - Country:US
Practice Address - Phone:920-683-4270
Practice Address - Fax:920-683-4908
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI721124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40952700Medicaid