Healthcare Provider Details

I. General information

NPI: 1609787092
Provider Name (Legal Business Name): JENNIFER POPOVICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 W VLIET ST
MILWAUKEE WI
53208-2698
US

IV. Provider business mailing address

716 W ABBOTT AVE
MILWAUKEE WI
53221-3635
US

V. Phone/Fax

Practice location:
  • Phone: 414-247-7383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number3590001506
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: