MEDICARE: JENNY STAVAST

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

General Provider Information

NPI Number	:	1831986520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY STAVAST

Provider Business Mailing Address
First Line	:	8336 AVON CT
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-3304
Country	:	US
Telephone Number	:	262-993-3297
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-1347
Country	:	US
Telephone Number	:	515-450-0700
Fax Number	:

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

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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Directions to “ JENNY STAVAST ” Practice Location

Language	Start Address	Practice Location

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