Provider Demographics
NPI:1366722613
Name:DEHN, JESSICA (LAT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:DEHN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HJORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:N91W15750 FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-2301
Mailing Address - Country:US
Mailing Address - Phone:262-532-1100
Mailing Address - Fax:
Practice Address - Street 1:N91W15750 FALLS PKWY
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2301
Practice Address - Country:US
Practice Address - Phone:262-532-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1216-0392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer