Provider Demographics
NPI:1932552247
Name:MIKLOS, COURTNEY (SPEECH PATHOLOGY)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MIKLOS
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 N WATER ST
Mailing Address - Street 2:APARTMENT #513
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-2061
Mailing Address - Country:US
Mailing Address - Phone:630-408-5006
Mailing Address - Fax:
Practice Address - Street 1:1635 N WATER ST
Practice Address - Street 2:APARTMENT #513
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-2061
Practice Address - Country:US
Practice Address - Phone:630-408-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4320-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist