Provider Demographics
NPI:1811019219
Name:ZIEHMKE, ANGELA JANE (SLP)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:JANE
Last Name:ZIEHMKE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W MAPLE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-4047
Mailing Address - Country:US
Mailing Address - Phone:177-355-1842
Mailing Address - Fax:815-572-5827
Practice Address - Street 1:215 W MAPLE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-4047
Practice Address - Country:US
Practice Address - Phone:177-355-1842
Practice Address - Fax:815-572-5827
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2067-154235Z00000X
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2067-154OtherSTATE OF WI SLP LICENSE