Basic Information
| Provider Information | |||||||||
| NPI: | 1871115972 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHLIE | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2927 S FISH HATCHERY RD | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116498 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2927 S FISH HATCHERY RD | ||||||||
| Address2: | |||||||||
| City: | FITCHBURG | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6088196810 | ||||||||
| FaxNumber: | 2242581400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2020 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 14338295 | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.