Healthcare Provider Details

I. General information

NPI: 1285741181
Provider Name (Legal Business Name): BETH E ZIEGENHAGEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-7772
  • Fax: 414-649-7977
Mailing address:
  • Phone: 414-389-2338
  • Fax: 414-385-8987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number407-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: