Healthcare Provider Details

I. General information

NPI: 1700723764
Provider Name (Legal Business Name): JENNIFER ZECHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HERMANN

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34700 VALLEY RD
OCONOMOWOC WI
53066-4500
US

IV. Provider business mailing address

868 WESLYN CT APT 8
WEST BEND WI
53095-4434
US

V. Phone/Fax

Practice location:
  • Phone: 262-646-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7587-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: