Provider Demographics
NPI:1366924243
Name:TRETTIN, JAMIE LYNN (LPC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:TRETTIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 LEE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-6574
Mailing Address - Country:US
Mailing Address - Phone:877-486-4140
Mailing Address - Fax:
Practice Address - Street 1:7950 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3131
Practice Address - Country:US
Practice Address - Phone:414-292-4242
Practice Address - Fax:414-540-1065
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIRBT-18-58833106S00000X
WI1858833106S00000X
WI10023-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician