Provider Demographics
NPI:1609323724
Name:NADLER, CONNIE (CCC-A/SLP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:NADLER
Suffix:
Gender:F
Credentials:CCC-A/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N6916 538TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-5591
Mailing Address - Country:US
Mailing Address - Phone:310-990-7783
Mailing Address - Fax:
Practice Address - Street 1:N6916 538TH ST
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-5591
Practice Address - Country:US
Practice Address - Phone:310-990-7783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3176-154235Z00000X
CA20236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist