Healthcare Provider Details

I. General information

NPI: 1053536664
Provider Name (Legal Business Name): KIMBERLY MARIE ZIETLOW MS-CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 N MAIN ST
AMHERST WI
54406-9102
US

IV. Provider business mailing address

6445 OAK DR
AMHERST WI
54406-9189
US

V. Phone/Fax

Practice location:
  • Phone: 715-824-5521
  • Fax:
Mailing address:
  • Phone: 715-347-1536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number820
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: