Provider Demographics
NPI:1023153251
Name:ZELLMER, PETER JOHN (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:ZELLMER
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 E WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-3969
Mailing Address - Country:US
Mailing Address - Phone:920-733-7525
Mailing Address - Fax:920-730-9403
Practice Address - Street 1:1336 E WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3969
Practice Address - Country:US
Practice Address - Phone:920-733-7525
Practice Address - Fax:920-730-9403
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI359-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41140700Medicaid
WI359-156OtherWI AUDIOLOGY LICENSE