Healthcare Provider Details

I. General information

NPI: 1386581346
Provider Name (Legal Business Name): GREEN BAY PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 SOUTHERN CROSS RD
GREEN BAY WI
54303-6500
US

IV. Provider business mailing address

981 SOUTHERN CROSS RD
GREEN BAY WI
54303-6500
US

V. Phone/Fax

Practice location:
  • Phone: 920-241-6707
  • Fax:
Mailing address:
  • Phone: 920-241-6707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HANNAH WESOLOWSKI
Title or Position: SPEECH LANGUAGE PATHOLOGIST/OWNER
Credential: M.S., CCC-SLP
Phone: 920-241-6707