Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jessica Provost

Individual provider Speech-Language Pathologist · NPI 1588014831

Jessica Provost is a Speech-Language Pathologist in De Pere, Wisconsin. Works from 2 locations. Licensed in Minnesota and Wisconsin.

Licensed in
MN, WI
In the registry since
2016
Specialties on file
2

Practice location Address checks out

1686 Eisenhower Rd
De Pere, WI 54115-8145
Phone: (920) 496-4700
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 100 County Road B, Shawano, WI 54166-7072 — (715) 526-7370

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence 5422 (WI)
Speech-Language Pathologist Taxonomy 235Z00000X · Licence 9673 (MN)

Record details

NPI number1588014831
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJune 17, 2016
Last updated in NPPESFebruary 15, 2022
Certification dateFebruary 15, 2022
Mailing address8170 33rd Ave S, Mail Stop 21110q, Minneapolis, MN 55425-4516

Other providers in De Pere