Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jodi Lorene Waddell

Individual provider Professional Counselor · NPI 1972272755

Jodi Lorene Waddell is a Mental Health Counselor in Mauston, Wisconsin. Qualified in 2022, 4 years ago. Practices with Pine Valley Integrated Services LLC, a 3-clinician group. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2021

Practice location Address checks out

124 Grayside Ave
Mauston, WI 53948-1913
Phone: (608) 847-7575
Fax: (608) 847-3096
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 12209-125 (WI)

Record details

NPI number1972272755
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedSeptember 7, 2021
Last updated in NPPESJanuary 23, 2026
Certification dateJanuary 23, 2026
Mailing addressS6908 Missel Rd, De Soto, WI 54624-6350

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Pine Valley Integrated Services Llc — 3 clinicians
Accepts Medicare assignment Not indicated

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