Healthcare Provider Details

I. General information

NPI: 1346288743
Provider Name (Legal Business Name): JANE LOPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 W 9TH ST
FOND DU LAC WI
54935-4956
US

IV. Provider business mailing address

11041 CEDAR CREEK RD
CEDARBURG WI
53012-8830
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: