Healthcare Provider Details

I. General information

NPI: 1669302881
Provider Name (Legal Business Name): JESSIE LENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1662 E KENNEDY AVE
KIMBERLY WI
54136-2362
US

IV. Provider business mailing address

86 E FOX POINT DR
LITTLE CHUTE WI
54911-4102
US

V. Phone/Fax

Practice location:
  • Phone: 920-687-3024
  • Fax:
Mailing address:
  • Phone: 920-687-3024
  • 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:
Title or Position:
Credential:
Phone: