Individual
JEANNE BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CADC
Contact information
Practice address
W156N8327 PILGRIM RD, MENOMONEE FALLS, WI 53051-3776
(262) 251-1112
(262) 251-1113
Mailing address
W156N8327 PILGRIM RD, MENOMONEE FALLS, WI 53051-3776
(262) 251-1112
(262) 251-1113
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
11174
WI
1041C0700X
Clinical Social Worker
Primary
3339-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40925700
—
WI
Enumeration date
07/22/2006
Last updated
12/03/2013
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