Jennifer Lynn Tennessen, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

18280-130 Issued in WI

Practice address

3301 N Ballard Rd Ste B
Appleton, WI 54911-9002

Phone

(920) 851-4468

NPI assigned

Aug 11, 2018

Last updated

Aug 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533945600000",
    "number": "1255810115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N472 KILSDONK CT",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549158726",
            "telephone_number": "920-851-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 N BALLARD RD STE B",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549119002",
            "telephone_number": "920-851-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TENNESSEN",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "SAC-IT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-11",
        "last_updated": "2018-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "18280-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Appleton, WI
• Providers in Appleton, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.