Provider Demographics
NPI:1730421058
Name:MARTIN, JENNIFER H (MA LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:H
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:H
Other - Last Name:STREETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPCC
Mailing Address - Street 1:4811 S 76TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4364
Mailing Address - Country:US
Mailing Address - Phone:414-325-7741
Mailing Address - Fax:414-325-7753
Practice Address - Street 1:4811 S 76TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4364
Practice Address - Country:US
Practice Address - Phone:414-325-7741
Practice Address - Fax:414-325-7753
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional