Healthcare Provider Details

I. General information

NPI: 1609700400
Provider Name (Legal Business Name): JENNIFER PIETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6273 WOODLAND DR
WAUNAKEE WI
53597-9256
US

IV. Provider business mailing address

1604 BELLEWOOD DR
WAUNAKEE WI
53597-2362
US

V. Phone/Fax

Practice location:
  • Phone: 608-849-2176
  • Fax:
Mailing address:
  • Phone: 608-354-6505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number102631
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: