Individual
JESSICA CLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
7151 EVERGREEN AVE, WISCONSIN RAPIDS, WI 54494-9587
(920) 454-0314
Mailing address
7151 EVERGREEN AVE, WISCONSIN RAPIDS, WI 54494-9587
(920) 454-0314
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
WI
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100045818
—
WI
Enumeration date
07/01/2015
Last updated
09/14/2023
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