Provider Demographics
NPI:1336400902
Name:SOWA, JENNIFER (DT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SOWA
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-2417
Mailing Address - Country:US
Mailing Address - Phone:262-287-8688
Mailing Address - Fax:855-747-1699
Practice Address - Street 1:5815 46TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-2417
Practice Address - Country:US
Practice Address - Phone:262-287-8688
Practice Address - Fax:855-747-1699
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2013-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No171R00000XOther Service ProvidersInterpreter