Healthcare Provider Details

I. General information

NPI: 1730025826
Provider Name (Legal Business Name): SHELLEY DAWN MILES M.S.CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLEY DAWN POLLMANN M.S.CCC-SLP

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 MADISON ST
FENNIMORE WI
53809-1432
US

IV. Provider business mailing address

520 MONROE ST
FENNIMORE WI
53809-1136
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-3285
  • Fax:
Mailing address:
  • Phone: 608-379-0253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590057373
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: