Provider Demographics
NPI:1851564686
Name:SLASKE, JENNIFER M (LPN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:SLASKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4902
Mailing Address - Country:US
Mailing Address - Phone:414-208-7362
Mailing Address - Fax:
Practice Address - Street 1:1537 S 64TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4902
Practice Address - Country:US
Practice Address - Phone:414-208-7362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-13
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309333-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35052700- PROVIDER #Medicaid