Provider Demographics
NPI:1205297959
Name:WILHELM, JENNA KRISTINE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:KRISTINE
Last Name:WILHELM
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 STATE ROUTE 281
Mailing Address - Street 2:
Mailing Address - City:HAMLER
Mailing Address - State:OH
Mailing Address - Zip Code:43524-9771
Mailing Address - Country:US
Mailing Address - Phone:419-966-3437
Mailing Address - Fax:
Practice Address - Street 1:205 NOLAN PKWY
Practice Address - Street 2:
Practice Address - City:ARCHBOLD
Practice Address - State:OH
Practice Address - Zip Code:43502-8404
Practice Address - Country:US
Practice Address - Phone:567-444-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist