Healthcare Provider Details

I. General information

NPI: 1770098352
Provider Name (Legal Business Name): JENNA WYSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA RICHARDSON

II. Dates (important events)

Enumeration Date: 12/05/2017
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 ROYALL AVE
ELROY WI
53929-1044
US

IV. Provider business mailing address

307 ROYALL AVE
ELROY WI
53929-1044
US

V. Phone/Fax

Practice location:
  • Phone: 608-462-8491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number5468-27
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: