Provider Demographics
NPI:1962375105
Name:HER-JACKSON, LUMINA (LPC-IT)
Entity type:Individual
Prefix:
First Name:LUMINA
Middle Name:
Last Name:HER-JACKSON
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6757 PEDERSON CROSSING BLVD APT 214
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-9216
Mailing Address - Country:US
Mailing Address - Phone:224-800-4279
Mailing Address - Fax:
Practice Address - Street 1:815 FORWARD DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2443
Practice Address - Country:US
Practice Address - Phone:608-268-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8734-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional