Individual
MS. JENNIFER I KOOP OLSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 955-0660
(414) 955-0076
Mailing address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-4874
(414) 955-0660
(414) 955-0076
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2558
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053362897
—
WI
05
—
39149800
—
WI
Enumeration date
05/15/2006
Last updated
05/02/2024
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