Healthcare Provider Details

I. General information

NPI: 1831552421
Provider Name (Legal Business Name): BARBARA JO NIGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA J FOTH

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 RIVER AVE S
PRAIRIE FARM WI
54762-9792
US

IV. Provider business mailing address

630 RIVER AVE S
PRAIRIE FARM WI
54762-9792
US

V. Phone/Fax

Practice location:
  • Phone: 715-455-1861
  • Fax: 715-455-1869
Mailing address:
  • Phone: 715-455-1861
  • Fax: 715-455-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2730-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: