Individual
CHANITA JEDLICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 N GRAND AVE, WAUKESHA, WI 53186-4913
(262) 547-1411
Mailing address
403 N GRAND AVE, WAUKESHA, WI 53186-4913
(262) 547-1411
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
14630-146
WI
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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