Individual
MR. JASON HETELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., CF-SLP
Contact information
Practice address
901 MULBERRY ST, LAKE MILLS, WI 53551-1335
(920) 648-8344
Mailing address
901 MULBERRY ST, LAKE MILLS, WI 53551-1335
(920) 648-8344
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4027-154
WI
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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