Provider Demographics
NPI:1851587620
Name:VICE, JANNA SUE (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:SUE
Last Name:VICE
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:SUE
Other - Last Name:HILLIARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:821 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1421
Mailing Address - Country:US
Mailing Address - Phone:608-834-2562
Mailing Address - Fax:
Practice Address - Street 1:825 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:WI
Practice Address - Zip Code:53925-1675
Practice Address - Country:US
Practice Address - Phone:920-623-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2791-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist