Active NPI
Jennifer L Petit, SAC-IT
- Addiction (Substance Use Disorder) Counselor
- Hayward, WI
National Provider Identifier
1790284966
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 18086-130
- Practice address
- 10592 Main St.
Hayward, WI 54843-6658 - Phone
- (715) 934-1381
- NPI assigned
- Feb 2, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 18086-130 | WI | Primary |
Addresses
Primary practice location
10592 Main St.
Hayward, WI 54843-6658
Mailing address
10592 Main Street
Hayward, WI 54843-6658
Phone (715) 934-1381
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18086-130 | WI | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1790284966",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10592 MAIN STREET",
"city": "HAYWARD",
"state": "WI",
"postal_code": "548436658",
"telephone_number": "715-934-1381"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10592 MAIN ST.",
"city": "HAYWARD",
"state": "WI",
"postal_code": "548436658",
"telephone_number": "715-934-1381"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETIT",
"first_name": "JENNIFER",
"middle_name": "L",
"credential": "SAC-IT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-02",
"last_updated": "2024-09-05",
"certification_date": "2024-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WI",
"license": "18086-130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.