Healthcare Provider Details

I. General information

NPI: 1033028618
Provider Name (Legal Business Name): NICOLE STANGLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 368TH AVE
BURLINGTON WI
53105-8583
US

IV. Provider business mailing address

118 PHEASANT RUN UNIT B
JOHNSON CREEK WI
53038-9684
US

V. Phone/Fax

Practice location:
  • Phone: 262-537-2216
  • Fax:
Mailing address:
  • Phone: 920-723-6826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: