Healthcare Provider Details

I. General information

NPI: 1568308096
Provider Name (Legal Business Name): NIKKI HANZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W DAYTON ST
MADISON WI
53703-1967
US

IV. Provider business mailing address

913 ROGER CT
WAUNAKEE WI
53597-9207
US

V. Phone/Fax

Practice location:
  • Phone: 608-513-6696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09145889
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: