Individual
MRS. NANCILYN K KETOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
2315 E MOORELAND ROAD, NEW BERLIN, WI 53151
(262) 798-7200
Mailing address
W194S8371 SUMMERIDGE CT, MUSKEGO, WI 53150-8165
(414) 687-1122
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2184-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710103494
—
WI
Enumeration date
04/18/2007
Last updated
09/26/2013
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