Healthcare Provider Details

I. General information

NPI: 1942117007
Provider Name (Legal Business Name): JACQUELYN KATT VERHULST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 N 53RD ST
MILWAUKEE WI
53223-5239
US

IV. Provider business mailing address

429 N 50TH ST
MILWAUKEE WI
53208-3635
US

V. Phone/Fax

Practice location:
  • Phone: 414-206-0551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number732843
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: