Doctor Name: | MRS. KELLY J FISK-WANZEK |
NPI Number: | 1083736102 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., CCC-SLP |
License Number: | 2827-154 |
Business Practice Address: | 28639 Laser Ave Redwood Falls, MN - 562832423 |
Business Phone Number: | 5076442017 |
Business Fax Number: | |
Mailing Address: | 28639 Laser Ave, REDWOOD FALLS |
State: | MN |
Postal Code: | 562832423 |
Phone Number: | 5076442017 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2827-154 |
Healthcare Provider Taxonomy: (Secondary) | N |
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 |