Active NPI
Joan Kristen Jeanetta
- Speech-Language Pathologist
- Superior, WI
National Provider Identifier
1750455838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 1763-154
- Practice address
- 3500 Tower Ave
Superior, WI 54880-5335 - Phone
- (715) 395-5454
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 1763-154 | WI | Primary |
Addresses
Primary practice location
3500 Tower Ave
Superior, WI 54880-5335
Mailing address
3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42775100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1763-154 | WI | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1750455838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805335",
"telephone_number": "715-395-5454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 TOWER AVE",
"city": "SUPERIOR",
"state": "WI",
"postal_code": "548805335",
"telephone_number": "715-395-5454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEANETTA",
"first_name": "JOAN",
"middle_name": "KRISTEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "WI",
"license": "1763-154",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "42775100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Superior, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.