Provider Demographics
NPI:1932720430
Name:BRUNNER, JORDAN BREE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:BREE
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:B
Other - Last Name:LESUER-MANDERNACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53082-0959
Mailing Address - Country:US
Mailing Address - Phone:920-783-6633
Mailing Address - Fax:920-783-6392
Practice Address - Street 1:908 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2430
Practice Address - Country:US
Practice Address - Phone:920-783-6633
Practice Address - Fax:920-783-6392
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4501-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health