Individual
JENNIFER MARIE HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PC-IT, SAC-IT
Contact information
Practice address
612 N RANDALL AVE, SUITE A, JANESVILLE, WI 53545-1958
(608) 752-7660
(608) 752-9788
Mailing address
612 N RANDALL AVE, SUITE A, JANESVILLE, WI 53545-1958
(608) 752-7660
(608) 752-9788
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1434-226
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16441-130
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1434-226
DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
01
—
16441-130
DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES
WI
Enumeration date
06/04/2012
Last updated
06/04/2012
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