Provider Demographics
NPI:1689787541
Name:CHILDREN'S HOSPITAL OF WISCONSIN
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF WISCONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOBLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-A
Authorized Official - Phone:414-266-2929
Mailing Address - Street 1:W147N10748 HERITAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4389
Mailing Address - Country:US
Mailing Address - Phone:262-502-7801
Mailing Address - Fax:
Practice Address - Street 1:W147N10748 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4389
Practice Address - Country:US
Practice Address - Phone:262-502-7801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI242-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41131100Medicaid