Individual
JACQUELINE PRUITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
3501 KINZIE AVE, RACINE, WI 53405-2438
(262) 664-8150
Mailing address
3546 OSBORNE BLVD, RACINE, WI 53405-2031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1001440500
WI
Other
Enumeration date
06/08/2026
Last updated
06/08/2026
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