Healthcare Provider Details

I. General information

NPI: 1265366363
Provider Name (Legal Business Name): JENNIFER KRYSCIO SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ELLSWORTH LN
BAYSIDE WI
53217-1827
US

IV. Provider business mailing address

W151N7514 WOOD VIEW DR
MENOMONEE FALLS WI
53051-4599
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-4213
  • Fax:
Mailing address:
  • Phone: 262-607-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: