Maxam, Jacqueline Nicole

Maxam, Jacqueline Nicole is an individual health care provider with primary practice located at 1520 N Meade St , Appleton WI 54911-3762. She recently has only one registered license in Speech, Language and Hearing Service Providers / Audiologist, which is considered as her primary health care specialty. Maxam, Jacqueline Nicole can be contacted via phone (920) 734-7181.

Contact Information

Primary practice address
1520 N Meade St Appleton WI 54911-3762
Phone: (920) 734-7181
Fax: (920) 734-0621
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Audiologist 231H00000X 471-156 Wisconsin

Profile Details

NPI number 1407055528
LBN Legal business name Maxam, Jacqueline Nicole
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2007
Last updated Oct 12th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407055528 NPPES
Wisconsin MEDICAID 41150900

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