Doctor Name: | JENNIFER LYNN COPPENS |
NPI Number: | 1205269420 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SAC-IT |
License Number: | 16732-130 |
Business Practice Address: | 9532 E 16 Frontage Rd Suite 100 Onalaska, WI - 546506739 |
Business Phone Number: | 6087830506 |
Business Fax Number: | |
Mailing Address: | 9532 E 16 Frontage Rd, Suite 100 ONALASKA |
State: | WI |
Postal Code: | 546506739 |
Phone Number: | 6087830506 |
Fax Number: | |
NPI Enumeration Date: | 08/12/2013 |
NPI Last Update Date: | 08/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 16732-130 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |