Individual
JANICE LYNNE FULLENWIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
702 W MAIN ST, MADISON, WI 53715-1424
(608) 280-2600
Mailing address
25 KESSEL CT, STE 105, MADISON, WI 53711-6227
(608) 280-2700
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3686-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43597100
—
WI
Enumeration date
04/04/2007
Last updated
09/07/2016
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