Healthcare Provider Details

I. General information

NPI: 1952243743
Provider Name (Legal Business Name): JESSICA MARCHETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S NICOLET RD
APPLETON WI
54914-8285
US

IV. Provider business mailing address

1120 APPLEWOOD DR
DE PERE WI
54115-7311
US

V. Phone/Fax

Practice location:
  • Phone: 309-825-9121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1521-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: