Individual
JODELL RAE PETIT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APSW, CSAC, ICS
Contact information
Practice address
13380 W TREPANIA RD, HAYWARD, WI 54843-2186
(715) 638-5102
(715) 634-6107
Mailing address
13380 W TREPANIA RD, HAYWARD, WI 54843-2186
(715) 638-5102
(715) 634-6107
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
128733-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386881522
—
WI
Enumeration date
01/09/2009
Last updated
06/18/2014
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