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General NPI Number Information
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NPI Number | 1821210709
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Entity Type | Individual
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Provider Name | MICELLE LYNN JABCZYNSKI M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8633 32ND AVE
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City | KENOSHA
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State | WI
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Zip | 53142-5187
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Country | US
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Telephone | 262-694-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 4131 S AUSTIN ST
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City | MILWAUKEE
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State | WI
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Zip | 53207-4423
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Country | US
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Telephone | 414-486-0864
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2710-154
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License Number State | WI
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