Provider Demographics
NPI:1154169068
Name:NURTURE: LANGUAGE & LACTATION
Entity type:Organization
Organization Name:NURTURE: LANGUAGE & LACTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULDA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CLC
Authorized Official - Phone:309-712-1089
Mailing Address - Street 1:2050 E PLANK RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-7041
Mailing Address - Country:US
Mailing Address - Phone:309-712-1089
Mailing Address - Fax:
Practice Address - Street 1:3301 N BALLARD RD STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-9002
Practice Address - Country:US
Practice Address - Phone:920-540-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty