Healthcare Provider Details

I. General information

NPI: 1639445299
Provider Name (Legal Business Name): JENNIFER SLOAN HOOVER MS/CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E TYRANENA PARK RD
LAKE MILLS WI
53551-9678
US

IV. Provider business mailing address

611 SHERMAN AVE E
FORT ATKINSON WI
53538-1960
US

V. Phone/Fax

Practice location:
  • Phone: 920-648-8170
  • Fax:
Mailing address:
  • Phone: 920-568-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3297-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: