Individual
JACQUELINE LEE LANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW CSAC
Contact information
Practice address
700 PILGRIM PKWY STE 203, ELM GROVE, WI 53122-2064
(262) 408-0588
(262) 599-8119
Mailing address
700 PILGRIM PKWY STE 203, ELM GROVE, WI 53122-2064
(262) 408-0588
(262) 599-8119
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11947
WI
1041C0700X
Clinical Social Worker
Primary
6864-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40922200
—
WI
Enumeration date
10/02/2006
Last updated
08/21/2025
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