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NPI Code Detail

MEDICARE: JESSICA HNILICKA

MEDICARE: JESSICA HNILICKA
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
1225700000XMassage Therapist4141-146WI

General Provider Information

NPI Number : 1790355881
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA HNILICKA
Provider Business Mailing Address
First Line : 312 E NORTH ST
Second Line :
City : DEFOREST
State : WI
Zip : 53532-1258
Country : US
Telephone Number : 308-846-3337
Fax Number :
Provider Business Practice Location Address
First Line : 312 E NORTH ST
Second Line :
City : DEFOREST
State : WI
Zip : 53532-1258
Country : US
Telephone Number : 308-846-3337
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2021
Last Update Date : 06/30/2021

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Directions to “ JESSICA HNILICKA ” Practice Location

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