Provider Demographics
NPI:1588747810
Name:SWEETLAND, JEAN ANNE (MSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANNE
Last Name:SWEETLAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:ANNE
Other - Last Name:SELSDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:827 WINFORD AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-4066
Mailing Address - Country:US
Mailing Address - Phone:920-494-6046
Mailing Address - Fax:
Practice Address - Street 1:1825 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2316
Practice Address - Country:US
Practice Address - Phone:920-437-7531
Practice Address - Fax:920-437-4067
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3521231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39616800Medicaid
WI39616800Medicaid