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General NPI Number Information
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NPI Number | 1750182275
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Entity Type | Individual
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Provider Name | JENNIFER HELEN STANIS APSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2025
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Last Update Date | 03/20/2025
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Provider Practice Location Address
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Address Line | 6321 23RD AVE
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City | KENOSHA
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State | WI
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Zip | 53143-4805
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Country | US
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Telephone | 414-455-3879
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 26TH AVE
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City | KENOSHA
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State | WI
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Zip | 53143-4705
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Country | US
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Telephone | 292-300-9558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 135296
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License Number State | WI
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