Individual
JESSICA YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, CMHIMP
Contact information
Practice address
129 KENOSHA ST, WALWORTH, WI 53184
(262) 607-2770
Mailing address
PO BOX 252, WALWORTH, WI 53184
(262) 607-2770
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5479-125
WI
Other
Enumeration date
10/16/2014
Last updated
11/16/2021
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