Provider Demographics
NPI:1033183330
Name:FRANTZ, JESSICA M (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:FRANTZ
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:M
Other - Last Name:MERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:1905 E HUEBBE PKWY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7395
Practice Address - Street 1:1969 W HART RD
Practice Address - Street 2:BELOIT HEALTH SYSTEM INC/ BELOIT MEMORIAL HOSPITAL
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2230
Practice Address - Country:US
Practice Address - Phone:608-364-5695
Practice Address - Fax:608-363-5790
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2749-154235Z00000X
IL146009773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42576600Medicaid