Healthcare Provider Details

I. General information

NPI: 1972413649
Provider Name (Legal Business Name): JENESSA NAWROCKI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 W CAPITOL DR
MILWAUKEE WI
53216-2040
US

IV. Provider business mailing address

3268 S EL DORADO DR
NEW BERLIN WI
53151-4204
US

V. Phone/Fax

Practice location:
  • Phone: 414-367-7121
  • Fax:
Mailing address:
  • Phone: 414-367-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: