Individual
JENNIFER K GAGNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5818 W CAPITOL DR, MILWAUKEE, WI 53216-2247
(414) 449-2114
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(414) 449-2114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070.026066
IL
225100000X
Physical Therapist
Primary
16115
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230064
—
WI
Enumeration date
09/16/2021
Last updated
10/03/2024
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