Healthcare Provider Details

I. General information

NPI: 1750206256
Provider Name (Legal Business Name): JENNA E TIMMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 25TH ST STE K
COLUMBUS IN
47201-3203
US

IV. Provider business mailing address

746 E BEAUMONT AVE
MILWAUKEE WI
53217-4811
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5699
  • Fax: 812-372-0279
Mailing address:
  • Phone: 414-581-8663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number46004975A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: