Provider Demographics
NPI:1164809356
Name:KLEMM, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KLEMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S7786 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53943-9646
Mailing Address - Country:US
Mailing Address - Phone:608-495-2405
Mailing Address - Fax:
Practice Address - Street 1:S7786 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:WI
Practice Address - Zip Code:53943-9646
Practice Address - Country:US
Practice Address - Phone:608-495-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319260-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse