Individual
JESEN DANIEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 EAST WASHINGTON ST, AFFILIATED CLINICAL SERVICES, WEST BEND, WI 53095
(262) 338-2717
(262) 338-9767
Mailing address
111 EAST WASHINGTON ST, AFFILIATED CLINICAL SERVICES, WEST BEND, WI 53095
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
5809 125
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
5809 125
WI
101YP2500X
Professional Counselor
Primary
5809 125
WI
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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