Healthcare Provider Details

I. General information

NPI: 1114783529
Provider Name (Legal Business Name): JESSICA ELAINE SLOWIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 4TH AVE
STEVENS POINT WI
54481-1910
US

IV. Provider business mailing address

N7680 BLACK OAK RD
DEERBROOK WI
54424-9260
US

V. Phone/Fax

Practice location:
  • Phone: 715-216-9105
  • Fax:
Mailing address:
  • Phone: 715-216-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: