Provider Information for 1477858058
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Ms. JENNIE RAE HAVILAND MS LMFT
Sex: Female
NPI: 1477858058
Last Updated: 2024-03-14
Certification Date: 2024-03-14
Certification Date: 2024-03-14
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1477858058 | ||||||||||||
| Enumeration Date | 2011-01-13 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3001 US HIGHWAY 12 E STE 225 MENOMONIE, WI 54751-3045 United States Phone: 715-231-2771 | Fax:715-232-5987 | ||||||||||||
| Primary Practice Address | 3001 US HIGHWAY 12 E STE 225 MENOMONIE, WI 54751-3045 United States Phone: 715-231-2771 | Fax:715-232-5987 | ||||||||||||
| Secondary Practice Address(es) | E5081 865TH AVE | ||||||||||||
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