Healthcare Provider Details

I. General information

NPI: 1063328235
Provider Name (Legal Business Name): CIARA ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 WEIS ST
ALLENTON WI
53002-9570
US

IV. Provider business mailing address

207 POLK ST
SLINGER WI
53086-9234
US

V. Phone/Fax

Practice location:
  • Phone: 262-644-9615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: