Provider Demographics
NPI:1013502715
Name:SPEED, JENNIFER (MS ED)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:SPEED
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2761 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-2407
Mailing Address - Country:US
Mailing Address - Phone:414-731-9978
Mailing Address - Fax:
Practice Address - Street 1:2761 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-2407
Practice Address - Country:US
Practice Address - Phone:414-731-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4896-266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional