Healthcare Provider Details

I. General information

NPI: 1841102779
Provider Name (Legal Business Name): JAMI LYNN NEWCOMB KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 35TH ST
KENOSHA WI
53140-5206
US

IV. Provider business mailing address

3803 8TH AVE
KENOSHA WI
53140-5536
US

V. Phone/Fax

Practice location:
  • Phone: 262-359-6099
  • Fax:
Mailing address:
  • Phone: 608-217-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590022910
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: