Doctor Name: | KRISTINE EDAHL |
NPI Number: | 1548375017 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA CCC |
License Number: | 746 |
Business Practice Address: | 333 Pine Ridge Blvd Wausau, WI - 544014120 |
Business Phone Number: | 7158472600 |
Business Fax Number: | 7158472626 |
Mailing Address: | 333 Pine Ridge Blvd, WAUSAU |
State: | WI |
Postal Code: | 544014120 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/21/2006 |
NPI Last Update Date: | 04/24/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 746 |
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 |