Provider Demographics
NPI:1467857367
Name:SCHLICHTMANN, JENNIFER (PTA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SCHLICHTMANN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:WI
Mailing Address - Zip Code:53820-9403
Mailing Address - Country:US
Mailing Address - Phone:608-732-2933
Mailing Address - Fax:
Practice Address - Street 1:3151 COUNTY ROAD CH
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-9108
Practice Address - Country:US
Practice Address - Phone:608-935-0194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2017-19225200000X
IA075842225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant