Individual
JESSICA LYNN BECKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
317 DEWITT ST, PORTAGE, WI 53901-2155
(608) 617-5400
Mailing address
555 OAKRIDGE DR, PORTAGE, WI 53901-1219
(608) 617-5400
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3590-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40997100
—
WI
Enumeration date
05/21/2007
Last updated
11/12/2012
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