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Individual

JENNA MAE DALGORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, APSW, SAC-IT

Contact information

Practice address
300 CROOKS ST, GREEN BAY, WI 54301-4527
(920) 436-6800
(920) 437-3540
Mailing address
PO BOX 22308, GREEN BAY, WI 54305-2308
(920) 436-6800
(920) 437-3540

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
20765
WI
1041C0700X
Clinical Social Worker
Primary
135092
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
135092
STATE LICENSE
WI
05
1801368493
WI
01
20765
STATE LICENSE SAC-IT
WI
Enumeration date
12/20/2018
Last updated
02/13/2025
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