Individual
CALLIE L JEROME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC SLP
Contact information
Practice address
251 FOREST LN, MONTELLO, WI 53949-9380
(608) 297-2153
(608) 297-9328
Mailing address
PO BOX 172, KINGSTON, WI 53939-0172
(920) 394-2010
(608) 297-9328
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2691154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42576800
—
WI
Enumeration date
03/29/2007
Last updated
07/09/2007
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