Provider Demographics
NPI:1861013989
Name:NENNIG, TALIA LYN (SLP)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:LYN
Last Name:NENNIG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:TALIA
Other - Middle Name:LYN
Other - Last Name:JASKULSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:W6127 LORNA LN
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-7465
Practice Address - Country:US
Practice Address - Phone:920-840-3033
Practice Address - Fax:920-882-4009
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5067-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist