Healthcare Provider Details

I. General information

NPI: 1912493735
Provider Name (Legal Business Name): NICOLE VROMAN M.S. CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2018
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CURRY LN
GREEN BAY WI
54311-5857
US

IV. Provider business mailing address

705 S 30TH ST
MANITOWOC WI
54220-4305
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-1161
  • Fax:
Mailing address:
  • Phone: 608-333-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4668-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: