Provider Demographics
NPI:1477796910
Name:HERKLOTZ, JENNIFER RENEE (MA, CCC-SLP, COM)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RENEE
Last Name:HERKLOTZ
Suffix:
Gender:F
Credentials:MA, CCC-SLP, COM
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:RENEE
Other - Last Name:LAFRENIERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP, COM
Mailing Address - Street 1:1025 W GLEN OAKS LN STE 107
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3372
Mailing Address - Country:US
Mailing Address - Phone:262-302-4166
Mailing Address - Fax:
Practice Address - Street 1:1025 W GLEN OAKS LN STE 107
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3372
Practice Address - Country:US
Practice Address - Phone:262-302-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3934-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist