Individual
MS. JANIS MARIE SOUTHWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA PC-TC
Contact information
Practice address
136 W BROADWAY AVE, MEDFORD, WI 54451-1757
(715) 748-4535
(715) 748-0627
Mailing address
136 W BROADWAY AVE, P O BOX 297, MEDFORD, WI 54451-1757
(715) 748-4535
(715) 748-0627
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1773-226
WI
Other
Enumeration date
08/20/2013
Last updated
10/22/2014
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