Provider Demographics
NPI:1023640083
Name:DERINGER, JENNIFER MICHELLE (MSSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MICHELLE
Last Name:DERINGER
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:MICHELLE
Other - Last Name:KRAKOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, CAPSW
Mailing Address - Street 1:322 SWEET ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-5323
Mailing Address - Country:US
Mailing Address - Phone:480-580-1901
Mailing Address - Fax:
Practice Address - Street 1:74 S MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-4274
Practice Address - Country:US
Practice Address - Phone:920-573-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9537-1231041C0700X
WI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty