Provider Demographics
NPI:1366982639
Name:WASHULESKI, JENNA (SAC-IT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:WASHULESKI
Suffix:
Gender:F
Credentials:SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3938
Mailing Address - Country:US
Mailing Address - Phone:920-651-1844
Mailing Address - Fax:920-651-1845
Practice Address - Street 1:502 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3938
Practice Address - Country:US
Practice Address - Phone:920-651-1844
Practice Address - Fax:920-651-1845
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17669-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)