Individual
JEREMY VERN WOODLIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
230 PARK ST, WAUTOMA, WI 54982-9031
(920) 787-6550
(920) 787-0421
Mailing address
PO BOX 1230, WAUTOMA, WI 54982-1230
(920) 787-6550
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
4018-226
WI
101YP2500X
Professional Counselor
Primary
8752-125
WI
Other
Enumeration date
09/10/2021
Last updated
01/04/2023
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