MEDICARE: JANINE MARIE PARK

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
1	235Z00000X	Speech-Language Pathologist	592841	WI

General Provider Information

NPI Number	:	1831029305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANINE MARIE PARK

Provider Business Mailing Address
First Line	:	W164N9795 WATER ST
Second Line	:
City	:	GERMANTOWN
State	:	WI
Zip	:	53022-5032
Country	:	US
Telephone Number	:	262-227-6649
Fax Number	:

Provider Business Practice Location Address
First Line	:	5910 N MILWAUKEE RIVER PKWY
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3816
Country	:	US
Telephone Number	:	414-351-7190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ JANINE MARIE PARK ” Practice Location

Language	Start Address	Practice Location

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