Provider Demographics
NPI:1306988951
Name:BUCKLI, NANCY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BUCKLI
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1647
Mailing Address - Country:US
Mailing Address - Phone:715-723-7110
Mailing Address - Fax:
Practice Address - Street 1:923 PERRY ST
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1647
Practice Address - Country:US
Practice Address - Phone:715-723-7110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI978-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI01099085OtherASHA IDENTIFICATION
WI42712900Medicaid
WI978-154OtherSPEECH LANGUAGE PATHOLOGY