Individual
MR. JOHN PETER JENDUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5225 NORTH IRONWOOD ROAD, 102, GLENDALE, WI 53217
(414) 962-9156
(414) 962-4356
Mailing address
5225 NORTH IRONWOOD ROAD, 102, GLENDALE, WI 53217
(414) 962-9156
(414) 962-4356
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2251-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39237400
—
WI
Enumeration date
08/27/2006
Last updated
08/26/2008
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