Provider Demographics
NPI:1447348552
Name:JENS, LORI ANN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:JENS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2210 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-4901
Mailing Address - Country:US
Mailing Address - Phone:920-457-2316
Mailing Address - Fax:
Practice Address - Street 1:1125 N 13TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3281
Practice Address - Country:US
Practice Address - Phone:820-208-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1832-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist