| Doctor Name: | JESSICA MARIE PANKRATZ |
| NPI Number: | 1003052572 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CAPSW, SAC |
| License Number: | 7533-123 |
| Business Practice Address: | 1250 Femrite Dr Ste 205 Monona, WI - 537163757 |
| Business Phone Number: | 6082233340 |
| Business Fax Number: | 6082233343 |
| Mailing Address: | 1250 Femrite Dr Ste 205, MONONA |
| State: | WI |
| Postal Code: | 537163757 |
| Phone Number: | 6082233340 |
| Fax Number: | 6082233343 |
| NPI Enumeration Date: | 01/05/2009 |
| NPI Last Update Date: | 06/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 7533-123 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |