Provider Demographics
NPI:1295865137
Name:SCHROCK, JESSICA M (AUD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:SCHROCK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 CHESTNUT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3060
Mailing Address - Country:US
Mailing Address - Phone:262-717-9000
Mailing Address - Fax:
Practice Address - Street 1:20720 WATERTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1823
Practice Address - Country:US
Practice Address - Phone:262-717-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
017380OtherKAISER-COMMERCIAL NUMBER
017380OtherKAISER-COMMERCIAL NUMBER