Individual
VIRGINIA V FENNEMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
6121 GREEN BAY RD, SUITE 220, KENOSHA, WI 53142-2926
(262) 652-7222
(262) 652-1734
Mailing address
6121 GREEN BAY RD, SUITE 220, KENOSHA, WI 53142-2926
(262) 652-7222
(262) 652-1734
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1507-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175724
VALUE OPTIONS
WI
05
—
39296200
—
WI
01
—
467366
PHCS
WI
Enumeration date
07/17/2006
Last updated
07/08/2007
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