Doctor Name: | JACQUELINE LEE LANDERS |
NPI Number: | 1043303787 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW LCSW CSAC |
License Number: | 11947 |
Business Practice Address: | 19275 W Capitol Dr Suite 200 Brookfield, WI - 530452742 |
Business Phone Number: | 2624080588 |
Business Fax Number: | 2623730362 |
Mailing Address: | 19275 W Capitol Dr, Suite 200 BROOKFIELD |
State: | WI |
Postal Code: | 530452742 |
Phone Number: | 2624080588 |
Fax Number: | 2623730362 |
NPI Enumeration Date: | 10/02/2006 |
NPI Last Update Date: | 07/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 11947 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |