Healthcare Provider Details

I. General information

NPI: 1033047501
Provider Name (Legal Business Name): EMILY NICKLAUS MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 KAPHAEM RD
TOMAHAWK WI
54487-7800
US

IV. Provider business mailing address

2331 PORTER RD
PLOVER WI
54467-2447
US

V. Phone/Fax

Practice location:
  • Phone: 715-453-2141
  • Fax:
Mailing address:
  • Phone: 920-901-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: