Individual
JEFFERY L WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
760 PILGRIM WAY, GREEN BAY, WI 54304-5263
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, PREVEA HEALTH, GREEN BAY, WI 54307-9070
(920) 496-4700
(920) 496-4705
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
440
WI
106H00000X
Marriage & Family Therapist
145
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39575700
—
WI
Enumeration date
07/26/2006
Last updated
01/24/2012
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