Individual
JESSICA MIJAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D, L.P.
Contact information
Practice address
505 BROADWAY ST, BARABOO, WI 53913-2183
(608) 355-4211
Mailing address
2005 TUMBLEWEED DR, PRAIRIE DU SAC, WI 53578-1189
(612) 382-7593
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
3026-57
WI
Other
Enumeration date
06/14/2012
Last updated
06/14/2012
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