Healthcare Provider Details

I. General information

NPI: 1346157161
Provider Name (Legal Business Name): JESSICA ANN KETO MS-CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N HAWLEY RD
MILWAUKEE WI
53208-2116
US

IV. Provider business mailing address

3448 S INDIANA AVE
MILWAUKEE WI
53207-3720
US

V. Phone/Fax

Practice location:
  • Phone: 414-256-8600
  • Fax:
Mailing address:
  • Phone: 414-687-8169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number645054
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: