Individual
JACQUELINE NICOLE MAXAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1520 N MEADE ST, APPLETON, WI 54911-3762
(920) 734-7181
(920) 734-0621
Mailing address
1520 N MEADE ST, APPLETON, WI 54911-3762
(920) 734-7181
(920) 734-0621
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
471-156
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41150900
—
WI
Enumeration date
07/18/2007
Last updated
10/12/2011
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