NPIMap

Jennifer L Bourgard, SAC

Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Ashland, WI

NPI 1356589501 · NPPES record last updated Jan 27, 2009

Key facts

NPI
1356589501
Entity type
Individual (NPI type 1)
Primary specialty
Addiction (Substance Use Disorder) Counselor 101YA0400X
License
15485-131 (WI)
Practice address
1635 Maple LN
Ashland, WI 54806-3610
Phone
(715) 685-5400
Fax
(715) 685-5102
NPI assigned
Jan 27, 2009
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
15485-131WIMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Medical Center Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 15485-131 WI Yes

Addresses

Primary practice location

1635 Maple LN
Ashland, WI 54806-3610

Mailing address

1635 Maple LN
Ashland, WI 54806-3610
Phone (715) 685-5400

Other providers in Ashland, WI

All providers in Ashland, WI · Addiction (Substance Use Disorder) Counselor in Wisconsin

Sources for this page

Verify at the official NPI Registry.