| Doctor Name: | CALLIE L JEROME |
| NPI Number: | 1952420713 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, CCC SLP |
| License Number: | 2691154 |
| Business Practice Address: | 251 Forest Ln Montello, WI - 539499380 |
| Business Phone Number: | 6082972153 |
| Business Fax Number: | 6082979328 |
| Mailing Address: | Po Box 172, KINGSTON |
| State: | WI |
| Postal Code: | 539390172 |
| Phone Number: | 9203942010 |
| Fax Number: | 6082979328 |
| NPI Enumeration Date: | 03/29/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2691154 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |