Individual
JENNY A INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CSAC,IDP-AT,PSIT
Contact information
Practice address
13380 W TREPANIA RD, HAYWARD, WI 54843-2186
(715) 638-5116
(715) 638-6107
Mailing address
13380 W TREPANIA RD, LAC COURTE OREILLES COMMUNITY HEALTH CTR, HAYWARD, WI 54843-2186
(715) 638-5100
(715) 634-6107
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
14547-131
WI
101YP2500X
Professional Counselor
Primary
2831
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39172000
—
WI
Enumeration date
06/10/2008
Last updated
08/16/2016
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