Provider Demographics
NPI:1932436474
Name:PAULSEN-KELLER, JENNIFER LEE (DPT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:PAULSEN-KELLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-3718
Mailing Address - Country:US
Mailing Address - Phone:262-705-3590
Mailing Address - Fax:
Practice Address - Street 1:89 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8411
Practice Address - Country:US
Practice Address - Phone:847-265-7300
Practice Address - Fax:847-265-7301
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87142251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics