Provider Demographics
NPI:1841492410
Name:WUTZKE, JENI E (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENI
Middle Name:E
Last Name:WUTZKE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16734 170TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARRETT
Mailing Address - State:MN
Mailing Address - Zip Code:56311-4101
Mailing Address - Country:US
Mailing Address - Phone:218-731-3496
Mailing Address - Fax:320-239-1420
Practice Address - Street 1:16734 170TH AVE
Practice Address - Street 2:
Practice Address - City:BARRETT
Practice Address - State:MN
Practice Address - Zip Code:56311-4101
Practice Address - Country:US
Practice Address - Phone:218-731-3496
Practice Address - Fax:320-239-1420
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7494235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist