Provider Demographics
NPI:1598874539
Name:O'BRIEN, JENNIFER K (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:K
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:K
Other - Last Name:WIPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD, CCC-A
Mailing Address - Street 1:1415 ELDORADO DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1775
Mailing Address - Country:US
Mailing Address - Phone:414-520-6565
Mailing Address - Fax:
Practice Address - Street 1:9000 W WISCONSIN AVE STE 340
Practice Address - Street 2:CHILDREN'S HOSPITAL OF WISCONSIN
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI438-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41149000Medicaid