MEDICARE: ALYSSA M WANNER CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	6467-154	WI

General Provider Information

NPI Number	:	1356071971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA M WANNER CCC-SLP

Provider Business Mailing Address
First Line	:	1752 DORSET LN
Second Line	:
City	:	NEW RICHMOND
State	:	WI
Zip	:	54017-2452
Country	:	US
Telephone Number	:	715-246-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 HEIGHTS DR
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6130
Country	:	US
Telephone Number	:	534-200-8101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	02/23/2026

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Directions to “ ALYSSA M WANNER CCC-SLP” Practice Location

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