Healthcare Provider Details

I. General information

NPI: 1467628057
Provider Name (Legal Business Name): KRISTEN LEIGH JANES MERTENS M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KRISTEN LEIGH JANES

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEMORIAL DR
BERLIN WI
54923-1243
US

IV. Provider business mailing address

225 MEMORIAL DR
BERLIN WI
54923-1243
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-5534
  • Fax: 920-361-5910
Mailing address:
  • Phone: 920-361-5534
  • Fax: 920-361-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2122-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: