Individual
MS. JANELLE ELIZABETH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.P.C.
Contact information
Practice address
7861 STATE ROAD 60, CEDARBURG, WI 53012-9305
(262) 546-1050
(262) 546-1051
Mailing address
7861 STATE ROAD 60, CEDARBURG, WI 53012-9305
(262) 546-1050
(262) 546-1051
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2708-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043314040
MEDICAID/NPI#
WI
05
—
21280000
—
WI
01
—
391706314
GROUP TAX IDENTIFICATION
WI
Enumeration date
09/11/2006
Last updated
09/07/2023
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