Dodd, Jaclyn L

Dodd, Jaclyn L is an individual health care provider with primary practice located at 200 S 9Th St , De Pere WI 54115-1393. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Dodd, Jaclyn L can be contacted via phone (920) 336-5680.

Contact Information

Primary practice address
200 S 9Th St De Pere WI 54115-1393
Phone: (920) 336-5680
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 1362-19 Wisconsin
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 1362 Wisconsin

Profile Details

NPI number 1427225721
LBN Legal business name Dodd, Jaclyn L
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date May 15th, 2008
Last updated Mar 14th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427225721 NPPES
Wisconsin MEDICAID 36139300
Wisconsin MEDICAID 1427225721

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