Provider Demographics
NPI:1962789719
Name:KOLODZIEJ, JENNA LEE (D,O)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LEE
Last Name:KOLODZIEJ
Suffix:
Gender:F
Credentials:D,O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 VERN HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8853
Mailing Address - Country:US
Mailing Address - Phone:715-344-1600
Mailing Address - Fax:
Practice Address - Street 1:5409 VERN HOLMES DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8853
Practice Address - Country:US
Practice Address - Phone:715-344-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63902-21207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology