Provider Demographics
NPI:1841485497
Name:WAERZEGGERS, EMILY MARGARGET
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MARGARGET
Last Name:WAERZEGGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 N PROSPECT AVE
Mailing Address - Street 2:APARTMENT 40
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1493
Mailing Address - Country:US
Mailing Address - Phone:920-819-4546
Mailing Address - Fax:
Practice Address - Street 1:N27W5707 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2852
Practice Address - Country:US
Practice Address - Phone:262-376-7676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2781154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42587000Medicaid