Provider Demographics
NPI:1992297568
Name:MARTENET, LINDA JEANNE (LPC IT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JEANNE
Last Name:MARTENET
Suffix:
Gender:F
Credentials:LPC IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 HICKORY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1134
Mailing Address - Country:US
Mailing Address - Phone:262-808-6525
Mailing Address - Fax:
Practice Address - Street 1:400 W RIVER DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53090-1518
Practice Address - Country:US
Practice Address - Phone:262-334-4340
Practice Address - Fax:262-334-4341
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7612-125101Y00000X
WI3872-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor