Organization
JASPER WELLNESS GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA L SUTHERS (CEO)
(920) 676-9697
Entity
Organization
Contact information
Practice address
1311 N DANZ AVE, GREEN BAY, WI 54302-3005
(920) 676-9697
Mailing address
2055 S TANAGER LN, SUAMICO, WI 54313-4003
(920) 676-9697
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
—
175T00000X
Peer Specialist
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
02/08/2024
Last updated
03/01/2024
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