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NPI Code Detail

MEDICARE: JAELYN CONNAUGHTY

MEDICARE: JAELYN CONNAUGHTY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerWI

General Provider Information

NPI Number : 1295509982
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAELYN CONNAUGHTY
Provider Business Mailing Address
First Line : 1499 6TH ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 888-974-5769
Provider Business Practice Location Address
First Line : 1499 6TH ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-2252
Country : US
Telephone Number : 920-497-6161
Fax Number : 888-974-5769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2023
Last Update Date : 04/07/2026

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Directions to “ JAELYN CONNAUGHTY ” Practice Location

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