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General NPI Number Information
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NPI Number | 1831986520
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Entity Type | Individual
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Provider Name | JENNY STAVAST
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Gender | Female
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1021 W NATIONAL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53204-1347
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Country | US
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Telephone | 515-450-0700
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Fax |
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Provider Business Mailing Address
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Address Line | 8336 AVON CT
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City | WAUWATOSA
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State | WI
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Zip | 53213-3304
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Country | US
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Telephone | 262-993-3297
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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 |
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License Number State |
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