Healthcare Provider Details

I. General information

NPI: 1326216292
Provider Name (Legal Business Name): JENN LYNN KOZOCHOWICZ CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 W LOOMIS RD SUITE 150
FRANKLIN WI
53132-8111
US

IV. Provider business mailing address

10500 W LOOMIS RD SUITE 150
FRANKLIN WI
53132-8111
US

V. Phone/Fax

Practice location:
  • Phone: 414-858-9223
  • Fax:
Mailing address:
  • Phone: 414-858-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2981-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: