Individual
MRS. CASEY JO AMBORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
626 EAST SLIFER ST, PORTAGE, WI 53901
(608) 742-8814
(608) 742-2384
Mailing address
P.O. BOX 564, 626 EAST SLIFER ST, PORTAGE, WI 53901
(608) 742-8814
(608) 742-2384
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42579800
—
WI
Enumeration date
09/11/2008
Last updated
07/09/2010
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