Provider Demographics
NPI:1780467134
Name:JENTZ, JENNIFER LYNN (LMT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:JENTZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:ASHAUER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:W6905 PARKVIEW DR STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-9099
Mailing Address - Country:US
Mailing Address - Phone:920-757-9887
Mailing Address - Fax:920-757-9887
Practice Address - Street 1:W6905 PARKVIEW DR STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-9099
Practice Address - Country:US
Practice Address - Phone:920-757-9887
Practice Address - Fax:920-221-3337
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5069-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist