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Speech, Language and Hearing Service Providers Speech-Language Pathologist

Provider NPI: 1114098506

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1100 LAKE VIEW DR  WAUSAU, WI 54403-6785 US
Tel: 715-848-4457  Fax: --

Business Mailing Address:
1100 LAKE VIEW DR  WAUSAU, WI 54403-6785 US
Tel: 715-848-4457  Fax: --

NPI Information:
NPI: 1114098506
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y235Z00000XSpeech, Language and Hearing Service Providers
Speech-Language Pathologist

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 235Z00000X





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