Provider Demographics
NPI:1669717526
Name:KILLORAN, NICHELE ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:NICHELE
Middle Name:ELIZABETH
Last Name:KILLORAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:NICHELE
Other - Middle Name:ELIZABETH
Other - Last Name:TAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1020 EVERGREEN PASS
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-3250
Mailing Address - Country:US
Mailing Address - Phone:715-931-0821
Mailing Address - Fax:
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI564-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist