Healthcare Provider Details

I. General information

NPI: 1932564531
Provider Name (Legal Business Name): NICOLE ZYGARLICKE CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS NICOLE BRANDON

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E WAUSAU AVE
WAUSAU WI
54403
US

IV. Provider business mailing address

5760 REGENT ST
STEVENS POINT WI
54482-9174
US

V. Phone/Fax

Practice location:
  • Phone: 715-842-2028
  • Fax:
Mailing address:
  • Phone: 715-347-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4651-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: