Plate, Jack A

Plate, Jack A is an sole proprietor health care provider with primary practice located at 4810 Northwestern Ave , Racine WI 53406-1504. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Plate, Jack A can be contacted via phone (262) 637-9984.

Contact Information

Primary practice address
4810 Northwestern Ave Racine WI 53406-1504
Phone: (262) 637-9984
Fax: (262) 637-9995
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X 698-123 Wisconsin
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 209-124 Wisconsin

Profile Details

NPI number 1053453340
LBN Legal business name Plate, Jack A
Credentials LCSW,LMFT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 13th, 2007
Last updated Sep 23rd, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053453340 NPPES
Wisconsin MEDICAID 39534500

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