Healthcare Provider Details

I. General information

NPI: 1720290562
Provider Name (Legal Business Name): MRS. JODY COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6062 N PORT WASHINGTON RD
MILWAUKEE WI
53217-4524
US

IV. Provider business mailing address

6062 N PORT WASHINGTON RD
MILWAUKEE WI
53217-4524
US

V. Phone/Fax

Practice location:
  • Phone: 414-332-3377
  • Fax:
Mailing address:
  • Phone: 414-332-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number248-156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: