Provider Demographics
NPI:1174952352
Name:HAFERMANN, JANELLE KATHLEEN (LPC, CSAC, ICS)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:KATHLEEN
Last Name:HAFERMANN
Suffix:
Gender:F
Credentials:LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W GRAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495-2781
Mailing Address - Country:US
Mailing Address - Phone:715-421-1107
Mailing Address - Fax:715-421-1108
Practice Address - Street 1:320 W GRAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495-2781
Practice Address - Country:US
Practice Address - Phone:715-421-1107
Practice Address - Fax:715-421-1108
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15834-132101YA0400X
WI10484-125101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100086570Medicaid