Provider Demographics
NPI:1992942981
Name:BRANTNER, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BRANTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 COUNTY HWY I
Mailing Address - Street 2:ST JOSEPHS HOSPITAL REHAB AGENCY/S.P.O.T.S.
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-1425
Mailing Address - Country:US
Mailing Address - Phone:715-726-3447
Mailing Address - Fax:715-726-3649
Practice Address - Street 1:2815 COUNTY HWY I
Practice Address - Street 2:ST JOSEPHS HOSPITAL REHAB AGENCY/S.P.O.T.S.
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-1425
Practice Address - Country:US
Practice Address - Phone:715-726-3447
Practice Address - Fax:715-726-3649
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist