Healthcare Provider Details

I. General information

NPI: 1669394706
Provider Name (Legal Business Name): MS. LAKIELA JANAYA HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 45TH ST
KENOSHA WI
53144-1940
US

IV. Provider business mailing address

3203 45TH ST
KENOSHA WI
53144-1940
US

V. Phone/Fax

Practice location:
  • Phone: 262-221-3422
  • Fax: 262-299-3635
Mailing address:
  • Phone: 262-221-3422
  • Fax: 262-299-3635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH6205307880205
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: