Provider Demographics
NPI:1588066351
Name:JARRETT, EMILY (LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:JARRETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 5TH AVE S STE 415
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4059
Mailing Address - Country:US
Mailing Address - Phone:608-782-8900
Mailing Address - Fax:608-782-8896
Practice Address - Street 1:205 5TH AVE S STE 415
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4059
Practice Address - Country:US
Practice Address - Phone:608-782-8900
Practice Address - Fax:608-782-8896
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2912-125101YP2500X
WI1914-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100042181Medicaid