| Doctor Name: | JODI L. FOSSUM |
| NPI Number: | 1962740258 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1627-226 |
| Business Practice Address: | W3275 Wolf River Road Menominee Tribal Clinic Keshena, WI - 541350970 |
| Business Phone Number: | 7157993361 |
| Business Fax Number: | 7157993099 |
| Mailing Address: | Po Box 970, Menominee Tribal Clinic KESHENA |
| State: | WI |
| Postal Code: | 541350970 |
| Phone Number: | 7157993361 |
| Fax Number: | 7157993099 |
| NPI Enumeration Date: | 01/22/2013 |
| NPI Last Update Date: | 01/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 1627-226 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |