Healthcare Provider Details

I. General information

NPI: 1972421105
Provider Name (Legal Business Name): ADALINE MAE DEKRAAI AUD, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FRANCES LN STE F
BEAVER DAM WI
53916-1167
US

IV. Provider business mailing address

1430 SYLVAN ST UNIT 118
OCONOMOWOC WI
53066-0015
US

V. Phone/Fax

Practice location:
  • Phone: 920-887-0509
  • Fax:
Mailing address:
  • Phone: 920-234-8542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1140156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: