Healthcare Provider Details

I. General information

NPI: 1841426541
Provider Name (Legal Business Name): ANNA MARIE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E WASHINGTON ST STE 1A
APPLETON WI
54911-5447
US

IV. Provider business mailing address

N308 CANDLELITE WAY
APPLETON WI
54915-8730
US

V. Phone/Fax

Practice location:
  • Phone: 920-852-5300
  • Fax: 920-852-5318
Mailing address:
  • Phone: 608-514-2382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10001461118
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: