Healthcare Provider Details

I. General information

NPI: 1275444689
Provider Name (Legal Business Name): JESSICA R HINTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

600 12TH ST
MOSINEE WI
54455-1003
US

IV. Provider business mailing address

600 12TH ST
MOSINEE WI
54455-1003
US

V. Phone/Fax

Practice location:
  • Phone: 715-693-2810
  • Fax: 715-693-1974
Mailing address:
  • Phone: 715-321-4393
  • Fax: 715-693-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1001338765
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: